In vitro comparison of intact endodontically treated teeth with and without endo-post reinforcement

In-vitro comparison of fracture resistance of CAD/CAM porcelain restorations for endodontically treated molars

BACKGROUND

This study evaluates the fracture strength and patterns of feldspathic porcelain restorations made using CAD/CAM technology for lower first molars with extensive crown destruction. The restorations include post-core and full-contour crown, composite resin core and full-contour crown, and endocrown. This research provides insights into effective restorative options to address tooth fracture risk, supporting minimally invasive procedures and CAD/CAM integration in dental practices.

METHODS

This study utilized 80 permanent mandibular first molars, which were divided into four groups: Group I (Post-Core-Full-contour crown), Group II (Core- Full-contour crown), Group III (Endocrown), and Group IV (Control). Root canal treatment was performed on all samples except for the control group. Following access cavity preparation, restorations for each tooth were fabricated using the CAD/CAM system and cemented with resin cement. The specimens were embedded in acrylic blocks. After undergoing thermomechanical aging, the samples were subjected to fracture resistance testing using a universal testing machine, which applied force until fracture occurred. The fracture patterns were subsequently analyzed, and the data were statistically evaluated using the Kruskal-Wallis and Chi-Square tests (p < 0.05).

RESULTS

A significant difference in fracture values under axial forces was observed (p < 0.05). The control group had the highest fracture strength (1830 ± 277 N), while the Core- full-contour crown group showed the lowest (1532 ± 371 N). Failure types varied significantly among the groups (χ2 = 26.886, df = 9, p = 0.001). The most common failure type was Type-2 (33.75%), characterized by restorable fractures, while Type-3 fractures, unrestorable, were the least common (12.5%).

CONCLUSIONS

The findings underscore the significance of technological advancements in CAD/CAM for effectively restoring endodontically treated teeth with extensive crown damage. This study contributes valuable insights, emphasizing the clinical relevance of selecting appropriate restorative options to mitigate the risk of tooth fracture associated with coronal restoration failures.

Surface strain at the cervical area and fracture strength of flared root canals reinforced using a zirconia tube and glass-fiber post

Background/purpose

Recently, an effective core build-up system for teeth with flared root canals is needed. This research aimed to evaluate the effect of foundation restorations using a composite resin core with a fiber post reinforced with a zirconia tube for the surface strain at the cervical area and the fracture load of teeth with flared root canals.

Materials and methods

Bovine teeth were shaped to mimic human premolars with flared root canals and restored using three types of composite resin foundation restorations with each materials described below: a fiber post (FC), a zirconia tube (ZC), a fiber post and zirconia tube (ZFC). Each specimen was restored with a zirconia crown. The surface strains of the specimens at the cervical area and fracture loads were analyzed using a one-way analysis of variance (ANOVA), followed by Tukey's honest significant difference test.

Results

The surface strains of Groups ZFC and ZC were significantly lower than that of Group FC in the buccal root. The fracture strengths of Groups ZFC and ZC were significantly higher than that of Group FC. The strength of Group ZFC was significantly higher than that of Group ZC.

Conclusion

The use of a composite resin core with a zirconia tube for the simulated premolar with flared root canals reduced surface strain at the cervical area and provided higher fracture strength compared to using a composite resin core with a fiber post. And the zirconia tubes provided even higher fracture strength when used with a fiber post.

Comparative effectiveness of fiber and metal posts in the restoration of endodontically treated teeth: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Different varieties of fiber and metal intraradicular posts have been used for the restoration of endodontically treated teeth with insufficient sound tooth structure. Evidence on the comparative efficacy of posts in a clinical setting is insufficient to provide clear clinical guidelines and recommendations.

PURPOSE

The purpose of this systematic review with network meta-analysis was to assess the comparative efficacy of fiber and metal posts used for the restoration of endodontically treated teeth.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until November 2022. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022384340). A network meta-analysis was performed on data from randomized controlled trials that assessed the comparative efficacy of fiber posts and metal posts for the restoration of endodontically treated teeth. Subgroup analyses were performed to compare all the varieties of fiber and metal posts. The types of posts were ranked according to their efficacy using the Surface Under the Cumulative Ranking (SUCRA) system. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the level of certainty of evidence.

RESULTS

Twenty-five articles were included in the quantitative analysis. Fiber posts (RR=0.15 [95% CI: 0.06, 0.33]) significantly prevented tooth fracture as compared with no posts. Prefabricated carbon fiber posts (RR=0.06 [95% CI: 0, 0.54]) ranked highest followed by custom glass fiber posts (RR=0.15 [95% CI: 0.04, 0.52]) and prefabricated glass fiber posts (RR=0.22 [95% CI: 0.07, 0.62]) in the outcome of tooth fracture. Metal posts (RR=0.24 [95% CI: 0.12, 0.46]) ranked higher than fiber posts (RR=0.39 [95% CI: 0.27, 0.56]) in the outcome of debonding. Custom gold alloy posts (RR=0.12 [95% CI: 0.03, 0.48]), prefabricated gold alloy posts (RR=0.04 [95% CI: 0.00, 0.87]), and prefabricated titanium posts (RR=0.21 [95% CI: 0.10, 0.45]) had higher rankings in the outcome of debonding or loss of retention of a post followed by custom glass fiber posts (RR=0.37 [95% CI: 0.21, 0.63]) and prefabricated glass fiber posts (RR=0.38 [95%CI: 0.25, 0.58]). Prefabricated glass fiber posts (RR=0.40 [95% CI: 0.20, 0.81]) had statistically significant differences in the outcome of secondary caries. The GRADE approach determined a moderate level of certainty of evidence.

CONCLUSIONS

The use of a fiber post when indicated results in reduced risk of tooth fracture as compared with no post. Prefabricated carbon fiber posts, prefabricated glass fiber posts, and custom glass fiber posts reveal a lower risk of tooth fracture. Overall, the use of prefabricated glass fiber posts had a lower risk of tooth fracture, debonding, and secondary caries. However, more trials with longer follow-up periods are recommended to enhance the certainty of evidence.

Stronger than Ever: Multifilament Fiberglass Posts Boost Maxillary Premolar Fracture Resistance

This paper investigates the influence of cavity configuration and post-endodontic restoration on the fracture resistance, failure mode and stress distribution of premolars by using a method of fracture failure test and finite elements analysis (FEA) coupled to Weibull analysis (WA). One hundred premolars were divided into one control group (G_contr) (n = 10) and three experimental groups, according to the post-endodontic restoration (n = 30), G₁, restored using composite, G₂, restored using single fiber post and G₃, restored using multifilament fiberglass posts (m-FGP) without post-space preparation. Each experimental group was divided into three subgroups according to the type of coronal cavity configuration (n = 10): G_1O, G_2O, and G_3O with occlusal (O) cavity configuration; G_1MO, G_2MO, and G_3MO with mesio-occlusal (MO); and G_1MOD, G_2MOD, and G_3MOD with mesio-occluso-distal (MOD). After thermomechanical aging, all the specimens were tested under compression load, and failure mode was determined. FEA and WA supplemented destructive tests. Data were statistically analyzed. Irrespective of residual tooth substance, G₁ and G₂ exhibited lower fracture resistance than G_contr (p < 0.05), whereas G₃ showed no difference compared to G_contr (p > 0.05). Regarding the type of restoration, no difference was highlighted between G_1O and G_2O, G_1MO and G_2MO, or G_1MOD and G_2MOD (p > 0.05), whereas G_3O, G_3MO, and G_3MOD exhibit higher fracture resistance (p < 0.05) than G_1O and G_2O, G_1MO and G_2MO, and G_1MOD and G_2MOD, respectively. Regarding cavity configuration: in G₁ and G_2, G_1O and G_2O exhibited higher fracture resistance than G_1MOD and G_2MOD, respectively (p < 0.05). In G₃, there was no difference among G_3O, G_3MO and G_3MOD (p > 0.05). No difference was found among the different groups and subgroups regarding the failure mode. After aging, premolars restored with multifilament fiberglass posts demonstrated fracture resistance values comparable to those of an intact tooth, irrespective of the different type of cavity configuration.

A composite resin core with a new zirconia tube reduces the surface strain at the cervical area of a mandibular molar: A model tooth study

PURPOSE

This study aimed to evaluate the surface strain at the cervical area of endodontically treated molars with a large pulp chamber restored using a composite resin core with three different types of core build-up systems.

METHODS

Reproduction models of human mandibular molars with prepared post spaces were used in this study. Roots duplicated with a composite resin were used as the experimental teeth. Three types of core build-up systems were used: composite resin core(RC), composite resin core with fiber posts (FC), and composite resin core with a prefabricated zirconia tube (ZC). Each group comprised eight specimens. Crowns made of yttria partially stabilized zirconia were cemented with dual-cure resin cement. Four strain gauges were attached to the surfaces of each specimen: the cervical area of the root and crown, on the buccal and lingual sides. The surface strain at each cervical area was measured using a static loading test and statistically analyzed.

RESULTS

In the case of static loading to the buccal cusp inner slope, ZC showed a significantly lower strain than RC in the crown on the buccal side and in the root and FC in the root. In the central fossa, ZC showed a significantly lower strain than FC in the root on the lingual side.

CONCLUSIONS

The prefabricated zirconia tube reduced the surface strain at the cervical area of the buccal/lingual root in molars; however, the effect was small in the cervical area of the crown.

Assessing dentists' knowledge and experience in restoring endodontically treated teeth using post & cores

OBJECTIVES

The restoration of endodontically, heavily filled teeth has been a challenge for the dental profession for decades. The aims of this study were to investigate dentists' experience and knowledge in the use of post & core when restoring endodontically treated teeth.

METHOD

This was a mixed method study incorporating quantitative and qualitative data collection. An online questionnaire was developed and distributed, comprised of 18 questions. It was calculated that 93 respondents were needed to validate the study of which 60% should meet a minimum knowledge requirement.

RESULTS

173 respondents completed the questionnaire. 109 (63% (95%CI56%,70%) demonstrated proficient knowledge of post & core restorations. Recent graduates were more likely to follow current guidelines (F = 4.570: P<0.034). As the age of respondent dentists increases the number of posts placed (F = 18.85; p<0.001) and the perceived confidence level increases (Spearman's Rho 0.43: P<0.01). Experience of postgraduate education also positively influenced clinical confidence.

CONCLUSION

The placement of post & cores is influenced by age. Confidence is also influenced by age. More evidence on post usage is required and several questions remain to be answered on what drives decision making and perceived long-term success.

CLINICAL SIGNIFICANCE

There is a general acceptance of when a post and core restoration should be used. Clinician experience and age can have an impact on what type of restorations are used. Fibre posts are more commonly used due their accessibility and cost.

Influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors

The aim is to evaluate the influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors. 150 maxillary central incisors were divided into three groups, Group 0, intact teeth; Group 1, removal of distal wall; Group 2, removal of mesial and distal walls, and further into two subgroups A₀,A₁,A₂ and B₀,B₁,B₂ according to post-endodontic restoration (post/no-post), then loaded to fracture. Interactions among variables and intergroup significance were tested with two-way ANOVA and Kruskal Wallis's tests (p≤0.05). Tukey's test was applied for multiple comparisons. Statistically significant differences were found between groups B₁-A₁, and B₂-A₂, but they were not found between B₀-A₀. Intragroup analysis showed statistically significant differences in both groups post/no-post with decreasing dental substance. Fiber post placement causes an increase in fracture strength and a reduction of irreparable fractures in endodontically treated maxillary central incisors that lost at least one wall.

State of the Art Contemporary Prefabricated Fiber-Reinforced Posts

Background:

There is an increased interest in investigating and use of prefabricated fiber-reinforced posts by scientists and clinicians in the restoration of endodontically treated teeth.

Objective:

The objective of this narrative review was to summarize the composition of contemporary prefabricated fiber-reinforced posts and elucidate its effect on the different properties of these posts.

Methods:

PubMed/Medline, Scopus, and Google Scholar were searched from January 1990 to December 2019 for English Language articles describing the composition and properties of prefabricated fiber-reinforced posts. First, the search strategy was established for Medline / PubMed using the following terms ((Fiber post[All Fields] OR (fiber reinforced post[All Fields] AND composition[All Fields] AND (“matrix”[MeSH Terms] OR (“fiber”[All Fields] AND “properties”[All Fields] AND “epoxy”[All Fields]) OR “dimethacrylate”[All Fields]) AND NOT (CAD CAM[All Fields])). The search strategy was then adapted for Scopus and Google Scholar databases to identify eligible studies.

Results:

The current state of the art of prefabricated fiber-reinforced posts revealed a myriad of products with different formulations which are reflected on the mechanical and handling characteristics of the different posts available in the market. More recent research and development efforts attempted to address issues related to the improved transmission of polymerization light through the post to the most apical end of the restoration inside the root canal. Others focused on the development of new matrix materials for fiber-reinforced posts.

Conclusion:

A review of the literature revealed that currently available prefabricated fiber-reinforced posts consist of a heterogeneous group of materials which can have a significant effect on the behavior of posts. Understanding different formulations will help clinicians in scrutinizing the vast literature available on prefabricated fiber-reinforced posts. This, in turn, will help them make an informed decision when selecting materials for the restoration of endodontically treated teeth.

A comparative evaluation of fracture resistance of endodontically treated premolar teeth reinforced with different prefabricated and custom-made fiber-reinforced post system with two different post lengths: An in vitro study

Aims

The aim of this study is to determine the mean failure load for each postsystem and the relationship between post lengths with the mean failure loads.

Materials and Methods

Ninety single-rooted decoronated mandibular premolar teeth were endodontically treated and randomly assigned to three groups with respect to their post length (2/3^rd and ½ of the root length). The first two groups were randomly divided into four subgroups, restored with the following postsystem: polyethylene-woven fiber posts, glass fiber tape, prefabricated carbon, and glass fiber posts. A composite core with no post served as control. All posts were cemented using dual-cure resin cement, and the same was used for core buildup. The standard cores were formed in each group. All the specimens were tested in a universal testing machine, and the load was calculated.

Results

One-way analysis of variance (ANOVA) showed that prefabricated glass fiber post had significantly highest fracture resistance when compared to other prefabricated and custom fiber-reinforced composite posts. Two-way ANOVA demonstrated no significant difference among the post lengths.

Conclusion

The results of this study showed that glass fiber posts showed higher fracture load, but post length did not significantly increase the fracture resistance of endodontically treated teeth.

Fracture resistance and marginal gap formation of post-core restorations: influence of different fiber-reinforced composites

OBJECTIVES

The aim was to explore the fracture behavior and marginal gap within the root canal of endodontically treated (ET) premolars restored with different fiber-reinforced post-core composites (FRCs). Further aim was to evaluate the composite curing at different depths in the canal.

MATERIALS AND METHODS

Eighty-seven intact upper premolars were collected and randomly divided into six groups. After endodontic procedure, standard MOD cavities were prepared and restored with their respective fiber-reinforced post-core materials: group 1: prefabricated unidirectional FRC-post + conventional composite core; group 2: prefabricated unidirectional FRC-post + short fiber composite (SFRC) core; group 3: individually formed unidirectional FRC-post + conventional composite core; group 4: randomly oriented SFRC directly layered as post and core; group 5: individually formed unidirectional FRC + randomly oriented SFRC as post and core. After restorations were completed, teeth (n = 3/group) were sectioned and then stained. Specimens were viewed under a stereo microscope and the percentage of microgaps within the root canal was calculated. Fracture load was measured using universal testing machine.

RESULTS

SFRC application in the root canal (groups 4 and 5) showed significantly higher fracture load (876.7 N) compared to the other tested groups (512-613 N) (p < 0.05). Post/core restorations made from prefabricated FRC-post (group 1) exhibited the highest number of microgaps (35.1%) at the examined interphase in the root canal.

CONCLUSIONS

The restoration of ET premolars with the use of SFRC as post-core material displayed promising performance in matter of microgap and load-bearing capacity.

CLINICAL SIGNIFICANCE

Fracture resistance of ET premolar restored by bilayered composite restoration that includes both SFRC as post-core material and surface conventional resin seems to be beneficial.

Effect of restoration technique on resistance to fracture of endodontically treated anterior teeth with flared root canals

This study was designed to compare the impact of post and core systems on resistance to fracture of endodontically treated anterior teeth with flared root canals and to assess their fracture pattern. Sixty central incisors were cut horizontally 2 mm coronal to the cementoenamel junction (CEJ). After root canal therapy, teeth were assigned into 6 groups (n=10 each) based on a post system and used as follows: Group C, non-flared root received size #1 glass fiber posts (Control); Group AP, flared root restored with anatomical post; Group RC, flared root restored with size #1 fiber post and cemented with thick layer of resin cement; Group CR, flared root restored with size #1 and reinforced with composite resin; Group CM, cast post-core; Group CP, CAD/CAM polymer-infiltrated ceramic post and core. Following post cementation, core build-up and crown insertion, the specimens were thermo-cycled up to 10,000 cycles (5C/55C; 30 seconds dwell time, 6 seconds transition time) and then statically loaded at 1 mm/minute crosshead speed using a universal testing machine. One-way ANOVA and Tukey HSD post hoc test (α=0.05) were used for data analysis. Group C recorded significantly higher resistance to fracture values [(826.9±39.1) N] followed by group CP [(793.8±55.6) N] while group RC yielded the lowest fracture resistance values [(586.7±51.4) N]. The resistance to fracture of wide root canals can be enhanced by using one-piece CAM/CAM post and core as an alternative to the use of either glass fiber post, relined with composite resin increasing the thickness of luting cement or the use of cast post and core system. However, this was an in vitro investigation and further in vivo studies are necessary.

Determination of the Optimum Material for an Endodontic Prefabricated Post Using a Sub-Problem Approximation Method

The success in the chewing process depends on the performance of the tooth used. Actually, taking care of the tooth and improving its performance can change our life. Therefore, the treatment process of the teeth has become more necessary in the life of a dental patient. Nowadays, a post plays an important vital role in this process. In the present work, analysis of the effect of the post material on the performances of the components of endodontically treated teeth (ETT) was carried out through the finite element analysis (FEA). The effects of post material on the von Mises stress component (Svon), shear stress, and displacement component (Usum) occurred on the all components of ETT were investigated. After that, the determination of the optimum material for an endodontic prefabricated post (EPP) was investigated through the sub-problem approximation method.

Effect of ferrule on the fracture resistance of mandibular premolars with prefabricated posts and cores

PURPOSE

This study evaluated fracture resistance with regard to ferrule lengths and post reinforcement on endodontically treated mandibular premolars incorporating a prefabricated post and resin core.

MATERIALS AND METHODS

One hundred extracted mandibular premolars were randomly divided into 5 groups (n=20): intact teeth (NR); endodontically treated teeth (ETT) without post (NP); ETT restored with a prefabricated post with ferrule lengths of either 0 mm (F0), 1 mm (F1), or 2 mm (F2). Prepared teeth were restored with metal crowns. A thermal cycling test was performed for 1,000 cycles. Loading was applied at an angle of 135 degrees to the axis of the tooth using a universal testing machine with a crosshead speed of 2.54 mm/min. Fracture loads were analyzed by one-way ANOVA and Tukey HSD test using a statistical program (α=.05).

RESULTS

There were statistical differences in fracture loads among groups (P<.001). The fracture load of F2 (237.7 ± 83.4) was significantly higher than those of NP (155.6 ± 74.3 N), F0 (98.8 ± 43.3 N), and F1 (152.8 ± 78.5 N) (P=.011, P<.001, and P=.008, respectively).

CONCLUSION

Fracture resistance of ETT depends on the length of the ferrule, as shown by the significantly increased fracture resistance in the 2 mm ferrule group (F2) compared to the groups with shorter ferrule lengths (F0, F1) and without post (NP).

Fracture resistance of endodontically treated teeth restored with Zirconia filler containing composite core material and fiber posts

Objectives:

To assess the fracture resistance of endodontically treated teeth with a novel Zirconia (Zr) nano-particle filler containing bulk fill resin composite.

Methods:

Forty-five freshly extracted maxillary central incisors were endodontically treated using conventional step back preparation and warm lateral condensation filling. Post space preparation was performed using drills compatible for fiber posts (Rely X Fiber Post) on all teeth (n=45), and posts were cemented using self etch resin cement (Rely X Unicem). Samples were equally divided into three groups (n=15) based on the type of core materials, ZirconCore (ZC) MulticCore Flow (MC) and Luxacore Dual (LC). All specimens were mounted in acrylic resin and loads were applied (Universal testing machine) at 130° to the long axis of teeth, at a crosshead speed of 0.5 mm/min until failure. The loads and the site at which the failures occurred were recorded. Data obtained was tabulated and analyzed using a statistical program. The means and standard deviations were compared using ANOVA and Multiple comparisons test.

Results:

The lowest and highest failure loads were shown by groups LC (18.741±3.02) and MC (25.16±3.30) respectively. Group LC (18.741±3.02) showed significantly lower failure loads compared to groups ZC (23.02±4.21) and MC (25.16±3.30) (p<0.01). However groups ZC (23.02±4.21) and MC (25.16±3.30) showed comparable failure loads (p=0.23).

Conclusions:

Fracture resistance of endodontically treated teeth restored with Zr filler containing bulk fill composite cores was comparable to teeth restored with conventional Zr free bulk fill composites. Zr filled bulk fill composites are recommended for restoration of endodontically treated teeth as they show comparable fracture resistance to conventional composite materials with less catastrophic failures.

The influence of crown ferrule on fracture resistance of endodontically treated maxillary central incisors

Background: Prefabricated zirconia posts can contribute to increasing the fracture resistance of the endodontically treated teeth. Purpose. This in vitro study compared the fracture resistance of endodontically treated central maxillary incisors prepared with 2mm ferrule length to the ones without ferrule. Material and methods: Twenty-four caries-free maxillary central incisors were divided into 2 groups of 12. In group A circumferential external dentin shoulders were prepared for 2mm external dentin ferrule length. There was no ferrule preparation in Group B. Zirconia VALLPOST BO-S (Ø 1,6mm), Ljubljana, Slovenia were used with retention forms in the coronary part. Core build-up was made of pressed ceramics (IPS e.max Press, Ivoclar, Liechtenstein). Crowns were manufactured from the same ceramic material (IPS e.max Press, Ivoclar). After root canal treatment and post space preparation, all posts were cemented with an adhesive resin cement (Multilink Automix, Ivoclar). The specimens were embedded in acrylic resin blocks (ProBase Polymer/Monomer, Ivoclar) and loaded at an angle of 45o to the long axis in an Instron Testing Machine 4301 (Instron Corp., USA) at a crosshead speed of 1mm/min until fracture. Fracture patterns and loads were recorded. A significance level of p<0.05 was used for all comparisons. Two-way analysis of variance was used for statistical analysis. Failure patterns were analyzed with the optical microscope Stereo Discovery V.8 (Carl Zeiss, Germany) and compared using the chisquare nonparametric test. Results: The mean values (±SD) of fracture loads (N) for the Groups A and B were 664.63N (±49.14) and 519.36N (±71.65) recpectively. Significantly lower failure loads were recorded for the specimens in the group B. Failure patterns within the groups revealed non-catastrophic failure in 70% of the specimens for group A and 85% for group B. Conclusions: Within the limitations of this in vitro study, it can be concluded that zirconia VALLPOST BO-S (Ø 1,6mm) with press-ceramic cores and crowns, can be used for restoration of endodontically treated teeth. The teeth prepared with 2mm external dentin ferrule length were found to be more fracture resistant than teeth without ferrule.

A comparison of the fracture resistances of endodontically treated mandibular premolars restored with endocrowns and glass fiber post-core retained conventional crowns

PURPOSE

This in-vitro study aimed to evaluate the fracture resistances and failure modes of endodontically treated mandibular premolars restored with endocrowns and conventional post-core retained crowns.

MATERIALS AND METHODS

Thirty mandibular premolars were assigned into three groups (n=10): GI, intact teeth; GE, teeth with endocrowns; GC, teeth with conventional post-core supported crowns. Except for the teeth in group GI, all specimens were cut to 1.5 mm above the cementoenamel junction and endodontically treated. Both endocrowns and conventional crowns were fabricated from lithium-disilicate blocks using a CEREC 3D CAD/CAM unit. All specimens were subjected to thermocycling and then to 45° oblique compressive load until fracture occurred. The fracture resistance and failure mode of each specimen were recorded. Data were analyzed with one-way ANOVA and LSD Post Hoc Test (α=.05).

RESULTS

The fracture resistances of GE and GC were significantly lower than that of GI (P<.01), while no significant difference was found between GE and GC (P=.702). As of the failure mode, most of the specimens in GE and GC were unfavorable while a higher occurrence of favorable failure mode was presented in GI.

CONCLUSION

For the restoration of mandibular premolar, endocrown shows no advantage in fracture resistance when compared with the conventional method. Both of the two methods cannot rehabilitate endodontically treated teeth with the same fracture resistances that intact mandibular premolars have.

Survey of dentists to determine contemporary use of endodontic posts

STATEMENT OF PROBLEM

Although the scientific literature provides sound decision-making tools for the restoration of endodontically treated teeth, dentists have different opinions on the rationale for the use of endodontic posts (dowels) and selection of post systems. The decision to place a post is at times contrary to the literature. Updated information on the treatment of endodontically treated teeth among general dentists is lacking.

PURPOSE

The purpose of this survey was to gain insight into the rationale for choice of endodontic posts and the different endodontic post systems currently used by dental practitioners. Post and core restorations distribute stress and replace missing tooth structure in endodontically treated teeth. Guidelines exist to help select post systems. With the advent of new materials, prefabricated posts have gained popularity among dentists. However, cast-metal post-and-core systems are still considered the gold standard.

MATERIAL AND METHODS

Surveys were distributed to dentists attending continuing education meetings in the United States, Canada, Scotland, Ireland, and Greece. The questions addressed years of practice, specialty training, and brand, type, shape, and material of the endodontic post systems used.

RESULTS

Descriptive statistical analysis was used to assess the percentage of respondents. Ninety-two percent of the participants were general practitioners with 25.94 ±13.35 years of experience. The majority agreed upon using endodontic posts when insufficient coronal tooth structure remains and for stress distribution. Passive, parallel posts were the most commonly reported type and shape. With regard to post material, fiber posts were the most frequently used (72.2%), followed by prefabricated alloys (38.6%), cast-metal posts (33.9%), prefabricated titanium posts (30.1%), and stainless-steel posts (21.7%). For cementation, resin-modified glass ionomer (40%) was most frequently used, followed by self-adhesive resin (29.6%).

CONCLUSIONS

The majority of the practitioners used fiber posts. This may be because, in terms of fracture, they compare favorably with cast-metal post and core, although little evidence in the literature validates this claim.

Fracture resistance of endodontically treated single rooted premolars restored with Sharonlay: An in vitro study

AIMS

The aim of this study is to compare in vitro the fracture resistance of the endodontically treated tooth restored with a novel design Sharonlay, with the two component restorative method, i.e., post with separate onlay, and onlay without post.

SUBJECTS AND METHODS

45 single-rooted mandibular second premolars were taken, and root canal treatment was performed. Teeth were then randomly divided into three groups (n = 15) based on the type of restoration given: Group I - metal onlay with cast post extension (Sharonlay), Group II - metal onlay with prefabricated metal post (Mani post system), Group III - metal onlay over endodontically treated tooth obturated with Gutta-percha (control group). Fracture resistance was checked using the Instron universal testing machine and the fracture patterns were analyzed.

RESULTS

According to the values recorded, Group I showed maximum mean fracture resistance followed by Groups II and III. Statistically significant difference was found between Groups I and II and Groups I and III and statistically significant difference was found between Groups II and III.

CONCLUSION

A single unit component Sharonlay, gives higher fracture resistance to a premolar as compared to (a) metal onlay with prefabricated metal post and (b) metal onlay over endodontically treated tooth.

Fracture resistance and failure mode of endodontically treated teeth restored using ceramic onlays with or without fiber posts-an ex vivo study

AIM

This study aimed to compare the fracture resistance and fracture modes of ceramic onlay restorations with or without fiber posts in endodontically treated premolars.

MATERIAL AND METHODS

Fifty extracted human premolars with similar anatomic features were used in this study. Four groups (n = 10) were treated endodontically. Onlay cavities extended to the buccal and palatal cusps and reached out the endodontic accesses were prepared. Ceramic onlay restorations with or without fiber posts were categorized as Group CO (ceramic onlays without posts), Group COQF (ceramic onlays and quartz fiber posts), and Group COGF (ceramic onlays and glass fiber posts). Positive control group was left as non-restored (Group NR). Ten intact teeth were stored as negative control group (Group IT). Fracture resistance was measured using a universal load-testing machine applying compressive load at a crosshead speed of 1 mm min(-1) until fracture. Fracture resistance and modes were evaluated statistically.

RESULTS

Ceramic onlay restorations (Groups CO, COQF, COGF) increased the fracture resistance significantly, when compared with non-restored teeth (P < 0.05). However, no significant differences were found in the groups with fiber posts in terms of fracture resistance (P > 0.05). Negative control group (IT) had significantly higher fracture resistance than all others (P < 0.05). Fracture types had significant differences among the groups (P < 0.01).

CONCLUSIONS

Within the limitations of this ex-vivo study, partial coverage with ceramic onlays resulted in a significant improvement of the fracture resistance of endodontically treated premolars. However, insertion of glass or quartz fibers did not increase the fracture resistance significantly.

Restoration of fractured endodontically treated mandibular first molar using custom made cast post and core

The successful treatment of posterior tooth with substantial damage to the tooth structure not only depends on root canal treatment but also by prompt restoration of lost coronal tooth structure. Endodontically treated teeth undergo loss of tooth substance due to dental caries, endodontic therapy or previous restoration and changes in physical characteristics, such as a reduced modulus of elasticity, which often leads to increased fracture susceptibility when compared to unrestored vital teeth.(1) Restoration of endodontically treated posterior teeth is more challenging because of their additional functional requirements. The restorative treatment of such teeth includes the decision of whether or not a post should be used. Post is a dental material placed in the root of structurally insufficient tooth when additional retention is needed to retain the core and coronal restoration.(2,3) However, preparation of a post space adds a certain degree of risk to restorative procedure like perforations and root fracture, especially if an over sized post channel is prepared.

Obturation Techniques Allow Microbial Leakage Unless Protected

PURPOSE

To evaluate the quality of the apical 5-mm seal produced by different filling techniques using a bacterial leakage model.

MATERIALS AND METHODS

Sixty-five extracted single-rooted human teeth were decoronated, prepared, and instrumented. Roots were randomly divided into three experimental groups (15 roots each) and control groups (10 roots each). The apical 5 mm was filled with cold lateral condensation (CLC) technique, continuous wave of condensation (CWC), or injectable thermoplasticized gutta-percha (Obtura II) using AH26 Plus as a sealer. Positive controls were filled with gutta-percha without sealer, whereas negative controls were filled with a CLC technique and covered completely with two layers of nail varnish, including the orifice. A dual-chamber leakage model using Enterococcus faecalis as a microbial marker was used for leakage evaluation. Bacterial penetration was monitored over a 60-day period, and leakage was recorded when turbidity was observed in the lower chamber.

RESULTS

All positive controls exhibited turbidity in the lower chamber within 24 hours. All negative controls demonstrated no bacterial leakage for the entire 60-day observation period. The estimated mean day for leakage was 32 for CLC, 35 for CWC, and 30 days for Obtura II. Wilcoxon test showed no statistically significant difference (p = 0.98) in the survival time between the experimental groups.

CONCLUSION

The three filling techniques produced similar resistance to bacterial leakage when used to fill the apical 5-mm segment of the canal while leaving the rest of the canal unfilled.

Endocrowns: review

The ideal restoration of endodontically treated teeth (ETT) has been widely and controversially discussed in the literature. Prevention of healthy dental structure is essential to help mechanical stabilization of tooth-restoration integrity, increase the amount of suitable surfaces for adhesion and thus positively affect the long-term success. ETT are affected by a higher risk of biomechanical failure than vital teeth. With the development of adhesive systems, the need for post-core restorations is also reduced. Especially for restoration of excessively damaged ETT, endocrowns have been used as an alternative to the conventional post-core and fixed partial dentures. Compared to conventional methods, good aesthetics, better mechanical performance, and less cost and clinic time are the advantages of endocrowns.

An assessment of fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in endodontically treated teeth: anin vitrostudy

Endodontically treated teeth with excessive loss of tooth structure would require to be restored with post and core to enhance the strength and durability of the tooth and to achieve retention for the restoration. The non-metallic posts have a superior aesthetic quality. Various core build-up materials can be used to build-up cores on the posts placed in endodontically treated teeth. These materials would show variation in their bonding with the non-metallic posts thus affecting the strength and resistance to fracture of the remaining tooth structure.

Aims. The aim of the study was to assess the fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in extracted endodontically treated teeth.

Material and Methods. Forty-five freshly extracted maxillary central incisors of approximately of the same size and shape were selected for the study. They were divided randomly into 3 groups of 15 each, depending on the types of non-metallic posts used. Each group was further divided into 3 groups (A, B and C) of 5 samples each depending on three core build-up material used. Student’s unpaired ‘t’ test was also used to analyse and compare each group with the other groups individually, and decide whether their comparisons were statistically significant.

Results. Luxacore showed the highest fracture resistance among the three core build-up materials with all the three posts systems. Ti-core had intermediate values of fracture resistance and Lumiglass had the least values of fracture resistance.

Strain measurements and fracture resistance of endodontically treated premolars restored with all-ceramic restorations

OBJECTIVES

The aim of this study was to investigate the recovery of cuspal stiffness and fracture resistance in endodontically treated maxillary premolars restored with bonded ceramic inlays and onlays of various designs.

METHODS

Seventy intact premolars were selected for this study; six cavity designs were investigated: (i) mesio-occlusal-distal (MOD) inlay (I), (ii) MOD inlay with palatal cusp coverage (IPC), (iii) MOD onlay (O), (iv) MOD inlay with pulp chamber extension (IPE), (v) MOD inlay with palatal cusp coverage and pulp chamber extension (IPCPE), and (vi) MOD onlay with pulp chamber extension (OPE). Intact teeth acted as control. Strain gauges were attached to the buccal and palatal surfaces of the teeth to measure cuspal stiffness under static loading. All specimens were eventually subjected to compressive load to failure. Cuspal stiffness and fracture resistance data were analyzed using ANOVA and Tukey test.

RESULTS

The I and IPE restorations restored cuspal stiffness to 75% of the sound tooth value. The O and OPE restored teeth had stiffness values greater than that of a sound tooth. The I, IPC, O, IPE, IPCPE and OPE restored teeth demonstrated fracture strength values of 938N±113 N (s.d.), 1073N±176 N and 1317N±219 N, 893N±129 N, 1062N±153 N and 1347N±191 N respectively.

CONCLUSIONS

Within the limitations of this study, it was concluded that the all-ceramic onlay or inlay with palatal cusp coverage provided best biomechanical advantage in restoring an endodontically treated maxillary premolar tooth.

CLINICAL SIGNIFICANCE

The onlay approach which is more conservative compared to full coverage restoration is considered an appropriate approach to the restoration of endodontically treated maxillary premolars. The addition of a pulpal extension to the all-ceramic restorations, apart from being technically challenging, was not found to offer any biomechanical advantage to the restored teeth.

Bleaching of a non-vital anterior tooth to remove the intrinsic discoloration

Intrinsic discoloration of a non-vital permanent incisor tooth due to trauma may have a significant esthetic and social impact on children and adolescents. Treatment options for discolored Non-vital teeth are bleaching, crowns or veneers. However, this restorative crown or veneer approach has a significant drawback of being an invasive technique. Intervention should be minimal destruction of tooth structure and should not compromise future restorative options. The advantage bleaching over crown is that it offers simple conservative approach in removal of stain and whitening discolored teeth without damaging tooth structure.

Fracture resistance of endodontically treated teeth restored with glass fiber reinforced posts and cast gold post and cores cemented with three cements

STATEMENT OF PROBLEM

Dental fractures can occur in endodontically treated teeth restored with glass fiber reinforced posts and cast gold posts.

PURPOSE

The objective of this study was to record the fracture strength of endodontically treated teeth restored with glass fiber reinforced or cast gold post and cores cemented with 3 cements.

MATERIAL AND METHODS

Forty-two single-rooted premolars with standardized weakened roots were endodontically treated and allocated to 6 experimental groups (n=7) defined by the 2 factors investigated: post system and cement. Three groups were restored with glass fiber posts and resin-modified glass ionomer cement, dual-polymerizing resin cement, or chemically active autopolymerizing resin cement. The other 3 groups were restored with cast gold post and cores and the same 3 cements. The cores of the glass fiber post groups were fabricated with composite resin core material. Metal crowns were cemented on the cores in the 6 groups. The entire system was subjected to continuous compression in a universal testing machine, and fracture limit and location (cervical third, middle third, or apical third) were noted. Two-way ANOVA and the Scheffé test were used to analyze the data and compare the groups (α=.05).

RESULTS

Two-way ANOVA showed significant differences in the post type (P<.001) and the cements (P<.001). The interaction between them (P<.001) was statistically significant in the fracture resistance of the endodontically treated teeth. The greatest interaction between post and cement was the glass fiber post with resin-modified glass ionomer cement, followed by the cast gold post and core with resin-modified glass ionomer cement.

CONCLUSIONS

The use of a glass fiber reinforced post and resin-modified glass ionomer cement increased the fracture resistance of endodontically treated teeth.

Fatigue susceptibility of an endodontic fibre post material

AIM

To evaluate effects of ageing and fatigue on the elastic modulus and short-beam shear strength of a quartz fibre/epoxy resin post material.

METHODOLOGY

Cylindrical specimens (25 × 2.2 mm) were made. Elastic moduli were dynamically measured before immersion in water; after immersion in water; periodically during storage in water for up to 7 years; periodically during thermal cycling in water for up to 10 000 cycles to produce thermo-mechanical fatigue; and periodically during boiling in water for up to 100 h. After ageing, the specimens underwent short-beam shear strength testing.

RESULTS

Elastic modulus was significantly decreased by thermal cycling and by immersion in boiling water, but not by water storage. Short-beam shear strength was profoundly decreased by all three ageing processes. Short-beam shear strength was much more sensitive than elastic modulus to the ageing or fatigue processes applied in this study.

CONCLUSIONS

A representative endodontic fibre post material was susceptible to a variety of ageing and fatigue processes. The effects of ageing and fatigue had a more pronounced impact on short-beam shear strength than on elastic modulus. The effects of boiling in water and thermal cycling in water were considerably larger than those of simple storage in water.

Comparative evaluation of fracture resistance of various post systems using different luting agents under tangential loading

OBJECTIVE

The purpose of this in vitro study was to evaluate the fracture resistance of various post system using different luting agents under tangential loading after wet thermocycling.

MATERIAL & METHODS

Seventy freshly extracted maxillary central incisors were endodontically treated and post-spaces were prepared to receive different post system. They were assigned to 7 groups. Composite resin was used as core material in all the groups. Three type of post system: prefabricated post system (ParaPost(®) XP™), fibre post (ParaPost(®) fiber Lux™), cast nickel-chromium alloy post and two type of luting cements dual cure resin cement (ParaCem(®), Whaledent) and glass ionomer cement (Fuji I, GC) were used. The specimens were thermocycled and subjected to tangential loading at a crosshead speed of 1.5 mm/min. The failure loads were recorded and data were statistically analyzed with one-way ANOVA (p < 0.05) and Student's t tests (p < 0.001).

RESULTS

Significant differences of fracture resistance were detected among groups (p < 0.001). The greatest number of repairable fracture mode was recorded in fibre posts and resin cement system.

CONCLUSIONS

Within the limitations of this in vitro study, it can be stated that fibre posts can be recommended as a better alternative to the cast post and cores and prefabricated metallic posts in the anterior region and resin cement might give additional fracture resistance when used for post and crown cementation.

Posts--when it all goes wrong! Part 1: case assessment and management options

Posts have been used for many years to retain restorations or cores for extra-coronal restorations in endodontically treated teeth.This article discusses the variety of post systems that are available and the incidence and reasons for failure of teeth that have been restored with posts. The treatment options available for the management of such failures are considered, in addition to the indications for both non-surgical and surgical management of endodontic failures. The attitudes of dentists and the perceived complications of attempting post removal are reviewed, along with the evidence to support the prevalence of complications.

CLINICAL RELEVANCE

Failure of post-retained restorations is a relatively frequent finding due to failure of the restoration itself or the endodontic treatment. It is therefore important to understand and be aware of the various treatment options available, their indications and associated risks.

The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: An in vitro study

Aim:

The aim of this study was to evaluate the fracture resistance of endodontically treated maxillary premolars with wide mesio-occluso-distal (MOD) cavities restored with either composite resin, or composite resin reinforced with different types of fibres.

Materials and Methods:

Fifty human maxillary premolars were selected. Five intact teeth served as positive controls. Endodontic therapy was carried out in the remaining forty-five teeth. Standardized MOD cavities were prepared in all the teeth. The teeth were restored with a nanocomposite using an incremental technique. These forty five teeth were randomly divided into three experimental groups (Group A, B and C) (n = 15). The teeth in Group A did not undergo any further procedures. The teeth in Group B and C were reinforced with composite impregnated glass fibre and polyethylene fibre, respectively. Fracture resistance was measured in Newtons (N).

Results:

The positive controls showed the highest mean fracture resistance (811.90 N), followed by Group B (600.49N), Group A (516.96N) and Group C (514.64N), respectively. One Way analysis of variance (ANOVA) test revealed a statistically significant difference between all the groups (P = 0.001). Post-hoc Tukey test revealed a moderately significant difference (P = 0.034) between Control and Group B, and a strongly significant difference between Control and Group A (P = 0.002), and Control and Group C (P = 0.001).

Conclusions:

Endodontic therapy and MOD cavity preparation significantly reduced the fracture resistance of endodontically treated maxillary premolars (P = 0.001). No statistically significant difference was found between the experimental groups (Group A, B and C) (P > 0.1). However, the fracture resistance of the composite impregnated glass fibre reinforced group was much higher than the others.

Finite element analysis and fracture resistance testing of a new intraradicular post

Objectives

The objective of the present study was to evaluate a prefabricated intraradicular threaded pure titanium post, designed and developed at the São José dos Campos School of Dentistry - UNESP, Brazil. This new post was designed to minimize stresses observed with prefabricated post systems and to improve cost-benefits.

Material and methods

Fracture resistance testing of the post/core/root complex, fracture analysis by microscopy and stress analysis by the finite element method were used for post evaluation. The following four prefabricated metal post systems were analyzed: group 1, experimental post; group 2, modification of the experimental post; group 3, Flexi Post, and group 4, Para Post. For the analysis of fracture resistance, 40 bovine teeth were randomly assigned to the four groups (n=10) and used for the fabrication of test specimens simulating the situation in the mouth. The test specimens were subjected to compressive strength testing until fracture in an EMIC universal testing machine. After fracture of the test specimens, their roots were sectioned and analyzed by microscopy. For the finite element method, specimens of the fracture resistance test were simulated by computer modeling to determine the stress distribution pattern in the post systems studied.

Results

The fracture test presented the following averages and standard deviation: G1 (45.63±8.77), G2 (49.98±7.08), G3 (43.84±5.52), G4 (47.61±7.23). Stress was homogenously distributed along the body of the intraradicular post in group 1, whereas high stress concentrations in certain regions were observed in the other groups. These stress concentrations in the body of the post induced the same stress concentration in root dentin.

Conclusions

The experimental post (original and modified versions) presented similar fracture resistance and better results in the stress analysis when compared with the commercial post systems tested (08/2008-PA/CEP).

Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

Ex vivo fracture resistance of endodontically treated maxillary central incisors restored with fiber-reinforced composite posts and experimental dentin posts

Aim:

To compare the fracture resistance of teeth restored with fiber-reinforced composite (FRC) posts and experimental dentin posts milled from human root dentin.

Materials and Methods:

Thirty maxillary central incisors were divided into three groups of ten each. Twenty teeth were restored with FRC posts and solid dentin posts and numbered as Groups 2 and 3 respectively while Group 1 acted as the control, without any post. The teeth were loaded at 135° angle to their long axes after core build-up and the failure loads were recorded.

Results:

One-way Analysis of Variance (ANOVA) and Bonferroni multiple comparisons revealed a significant difference among test groups with the control group showing the highest fracture resistance, followed by the dentin post group and lastly the FRC post group.

Conclusions:

Teeth restored with dentin posts exhibited better fracture resistance than those restored with FRC posts.

Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: an in vitro study

INTRODUCTION

This investigation sought to compare the fracture resistance under static and fatigue loading of endodontically treated teeth restored with fiber-reinforced composite posts and experimental dentin posts milled from human root dentin by using computer-aided design/computer-aided manufacturing.

METHODS

Seventy maxillary central incisors were obturated and divided into 4 groups: control group without any post (n = 10), carbon fiber post group (n = 20), glass fiber post group (n = 20), and dentin post group (n = 20). Control group teeth were prepared to a height of 5 mm. In all other teeth, post space was prepared; a post was cemented, and a core build-up was provided. Half the samples from each group were statistically loaded until failure, and the remaining half were subjected to cyclic loading, followed by monostatic load until fracture.

RESULTS

One-way analysis of variance and Bonferroni multiple comparisons revealed a significant difference among test groups. The control group demonstrated highest fracture resistance (935.03 ± 33.53 N), followed by the dentin post group (793.12 ± 33.69 N), glass fiber post group (603.44 ± 46.67 N), and carbon fiber post group (497.19 ± 19.27 N) under static loading. These values reduced to 786.69 ± 29.64 N, 646.34 ± 26.56 N, 470 ± 36.34 N, and 379.71 ± 13.95 N, respectively, after cyclic loading.

CONCLUSIONS

Results suggest that human dentin can serve as post material under static and fatigue loading. Although at an early stage in research, the use of dentin posts in root-filled teeth looks promising.

Comparison of fracture strength of endocrowns and glass fiber post-retained conventional crowns

The aim of this in vitro study was to compare the fracture strength of full ceramic crowns using two techniques-indirect conventional crowns retained by glass fiber posts, and endocrowns with an "anchorage" in the pulp chamber-and analyze the failure mode. For this purpose, 20 healthy mandibular molars were divided into two groups (n=10): GroupGC contained teeth with indirect conventional crowns, filling cores, and glass fiber posts; Group GE contained teeth with restorations of the endocrown type. Teeth were endodontically treated and prepared for ceramic restorations fabricated by the injection technique(IPS e.max Press, Ivoclar-Vivadent), forming the GC and GE groups. Specimens were mount-ed in a universal test machine (EMIC) and were submitted to an oblique compression load, at an angle of 135 degrees to the long axis of the tooth, until failure. Statistical evaluation performed by the Mann-Whitney nonparametric test showed significant differences between the two groups (p=0.002), with Group GE shown to be more resistant to compressive forces than Group GC. The pre-dominant failure pattern in both groups was fracture of the tooth on the side of force application and/or consequent displacement of the restoration on the opposite side.