The effect of post type and length on the fracture resistance of endodontically treated teeth

Fatigue and failure analysis of restored endodontically treated maxillary incisors without a dowel or ferrule

STATEMENT OF PROBLEM

Information on the survival and mode of failure of endodontically treated incisors without a ferrule and restored without dowels is lacking.

PURPOSE

The purpose of this in vitro study was to compare the survival and failure mode of endodontically treated incisors without a ferrule and restored with bonded ceramic crowns and various composite resin foundation restorations without dowels with a control group with fiber dowels.

MATERIAL AND METHODS

Forty-five decoronated endodontically treated bovine incisors without ferrule were divided into 3 experimental groups and restored with different adhesive foundation restorations without dowel: nanohybrid composite resin (Nd), bulk-fill composite resin foundation restoration (NdB), and fiber-reinforced bulk-fill composite resin (NdFR). A control group with conventional foundation restorations (glass-fiber dowel with nanohybrid composite resin foundation restoration without ferrule) (D) was included for comparison. All teeth were prepared to receive bonded lithium disilicate ceramic crowns luted with dual-polymerizing composite resin cement and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30 degrees and a frequency of 5 Hz, beginning with a load of 100 N (5000 cycles). A 100-N load increase was applied each 15 000 cycles. Specimens were loaded until failure or to a maximum for cycles endured of 1000 N (140 000 cycles). Groups were compared by using the Kaplan-Meier survival analysis (log rank test at α=.05 and pairwise post hoc comparisons) and life table analysis for load-at-failure (followed by Wilcoxon pairwise comparison α=.05).

RESULTS

All the specimens failed before 140 000 load cycles. Even though no statistically significant differences were found between the experimental groups without dowel (P>.127), the fiber-reinforced foundation restoration yielded the highest mean ±standard deviation cycles to failure (46 023 ±4326) compared with Nd (38 899 ±2975) and NdB (39 751 ±2998). NdFR, however, outperformed the foundation restoration with glass-fiber dowel (35 026 ±2687) (P<.05). Most failure in groups without dowel were restorable, while 100% of catastrophic failure (unrestorable) were found in the group with dowels.

CONCLUSIONS

Based on the present in vitro study, dowels did not improve the performance of the adhesive restoration of endodontically treated incisors without a ferrule. The use of a short fiber-reinforced composite resin foundation restoration without a dowel was able to not only improve the resistance of the restorations compared with adhesive foundation restorations with dowels but also minimize catastrophic failures.

Effect of Different Post Materials and Adaptability on Fracture Resistance and Fracture Mode in Human Endodontically Treated Teeth

Objective. To investigate the effect of different post materials and adaptability on fracture resistance and fracture mode of endodontically treated teeth. Materials and Methods. Sixty extracted human mandibular premolars were selected and divided into 6 groups (n = 10) according to the restorative method after endodontic treatment: no ferrule presented and restored without fiber post (Group C), 2.0 mm ferrule presented and restored without fiber post (Group CF), restored with D.T. Light-Post (Group PDT), restored with anatomically customized D.T. Light-Post, relined with resin composite (Group ADT), restored with Hi-Rem prosthetic post (Group PHR), and restored with anatomically customized Hi-Rem prosthetic post, relined with resin composite (Group AHR). After restoring with core build-up materials, all specimens were loaded at 45° in a universal testing machine until failure. Visual inspection of all specimens for fracture modes was performed. The data were analyzed using one-way ANOVA, and the fracture mode was reviewed using the chi-square test. Results. Anatomically customized groups presented statistically significant higher fracture resistance than prefabricated groups and group C ( $P<0.05$ ). Without post, group CF displayed significantly higher fracture resistance than group C ( $P<0.05$ ). Group C, CF, PDT, and PHR showed some specimens with unfavorable fractures. Conclusions. Anatomically customized posts presented highest fracture resistance among all groups. There was no significant difference in fracture mode across all groups.

Fracture resistance of endodontically-treated maxillary premolars restored with different type of posts and direct composite reconstructions: A systematic review and meta-analysis of in vitro studies

OBJECTIVE

To conduct a systematic review and meta-analysis to assess if the presence of an endodontic post may increase the fracture resistance of endodontically-treated maxillary premolars directly restored with composite.

METHODS

A comprehensive systematic literature search according to the PRISMA statement was conducted to assess in vitro studies including endodontically-treated maxillary premolars, restored with different type of posts supporting direct composite reconstructions. Two groups of meta-analyses were performed using fixed effects model and additional Trial Sequential Analysis (TSA) was carried out. Moreover, risk of bias was conducted and quality of evidence for any performed meta-analysis was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Twenty-four articles met the inclusion criteria and 13 studies also underwent quantitative evaluation. Fracture resistance of endodontically-treated premolars restored with fiber posts was significantly less than sound teeth (p value: < 0.00001), however endodontically-treated premolars with a fiber post provided an increase in fracture resistance when compared to equivalent teeth restored without post (p value: 0.003). TSA revealed high power of both meta-analyses. Moderate risk of bias was reported in 23/24 studies; only 1 study showed high risk of bias. GRADE system showed moderate strength of evidence due to the presence of a study with high risk of bias and to wide confidence intervals.

SIGNIFICANCE

Within the limitation of the present systematic review and meta-analysis, it can be concluded that endodontically-treated maxillary premolars restored with a fiber post and direct composite restoration demonstrated increased fracture resistance when compared to equivalent teeth without post.

Fracture strength of endodontically treated premolars restored with different post systems and metal-ceramic or monolithic zirconia crowns

The purpose of this study was to investigate the fracture strength of endodontically treated human maxillary premolars (ETP) restored with posts and metal ceramic (MC) or monolithic zirconia (MZ) crowns. Sixty ETP were randomly divided into 3 groups. Teeth in control group (C) received a resin filling. ETP in the MC group were restored with prefabricated metal posts, composite cores and MC crowns while in the MZ group with glass-fiber posts, composite cores and MZ crowns. Half of the specimens were loaded at a 135° angle and half under axial loading until fracture. The fracture modes were divided in repairable and irreparable using optical microscopy. Mean fracture strength was significantly higher for MC than for MZ crowns and control group only under axial loading. The distribution of repairable and irreparable failures presented no significant differences. Crown placement significantly improved the fracture strength of ETP irrespectively of post and crown type.

Resistance to fracture of intraradicular posts made of biological materials

Background

The aim was to analyze the fracture resistance of human teeth treated endodontically and restored with posts made of bovine dentin, human dentin, or glass fiber, and to evaluate the fracture pattern.

Methods

Cylindrical posts of 1.5 mm in diameter cemented to the roots of human maxillary canines presented a length of 15 mm, cervical diameter of 5–5.5 mm in the mesiodistal direction, and 7–7.5 mm in the vestibule-palatal direction. The groups studied were: Group I—10 glass fiber posts; Group II—10 human dentin posts; Group III—10 bovine dentin posts (self-adhesive resin cement); and Group IV—10 bovine dentin posts (resin-modified glass-ionomer cements). The coronal part of tooth was restored with a standardized core build-up using composite. All of the groups were submitted to a compression force test and the resistance to fracture was verified using a universal testing machine. The fracture pattern was likewise evaluated.

Results

The values of resistance to fracture were: 723.3N in group I, 561.5N in group II, 556.6N in group III, and, 613.27N in group IV. However, no statistically significant difference was observed among the groups. The fractures in groups I and II were most commonly found in the middle/apical third and were considered irreparable. For restored teeth in group III, half of the fractures appeared in the cervical third and were reparable. In group IV, all of the fractures were reparable, with the majority in the cervical thirds.

Conclusion

Bovine dentin can be used as intraradicular post to substitute human dentin and glass fiber posts. The greater the malleability of the post, the greater the chances of survival of the teeth when subjected to fracture testing.

A comparison of the fracture resistance of premolars without a ferrule with different post systems

STATEMENT OF PROBLEM

Which type of post improves the performance of endodontically treated mandibular premolars without a ferrule remains unclear.

PURPOSE

The purpose of this in vitro study was to compare the restoration of endodontically treated mandibular premolars without a ferrule by using different post systems.

MATERIAL AND METHODS

Thirty extracted mandibular premolars were endodontically treated, and their crowns removed. They were divided into 3 groups with different post systems (n=10): zirconia ceramic posts (ZRPs), fiber posts (FPs), and bundled glass fiber-reinforced composite resin posts (GTPs). After post placement and core fabrication, computer-aided design and computer-aided manufacture (CAD-CAM) lithium disilicate crowns were cemented. The specimens were subjected to thermocycling and mastication simulation before a fracture test in a universal testing machine. The maximum load at which the fracture occurred was recorded, and the fractured specimens were examined by using an optical microscope. The data were analyzed for statistical differences with a 1-way ANOVA and the Tukey honestly significant difference post hoc test (α=.05).

RESULTS

No statistically significant difference in fracture strength was found among the groups (P=.970). From the light microscopy examination, catastrophic failure was observed in all specimens, and there was no failure of the ceramic crowns.

CONCLUSIONS

Based on the findings of this in vitro study, the choice of post material with a low or high modulus of elasticity did not prevent catastrophic failures in endodontically treated teeth without a ferrule.

Development of a fiber-reinforced material for fiber posts: Evaluation of stress distribution, fracture load, and failure mode of restored roots

STATEMENT OF PROBLEM

The biomechanical behavior of post-restored roots with an experimental fiber-reinforced composite resin is unknown.

PURPOSE

The purpose of this in vitro study was to investigate the biomechanical behavior of an experimental composite resin (3-mm short glass fiber incorporated in methacrylate matrix with filler particles) used to produce the custom post itself or to reline fiber posts.

MATERIAL AND METHODS

Four testing groups (n=10) were created according to the root restoration method: FG, commercially available fiber post; FG+RC, fiber post relined with conventional composite resin; FG+EXP, fiber post relined with the experimental composite resin; and EXP, a custom post made of experimental composite resin. A three-dimensional finite element linear elastic analysis was performed by using geometric representations of groups, and the results were analyzed by von Mises (σ_vM) and maximum principal stress criteria. In sequence, 40 bovine incisors were assigned to these groups and subjected to a fracture load test (Instron 5965; 0.5 mm/min), and the failure mode was determined.

RESULTS

The EXP group showed more homogeneous stress distribution for σ_vM. ANOVA and the Tukey honestly significant difference (HSD) tests showed significant differences (P<.001) in fracture load (mean ±standard deviation; different superscript letters indicate statistical difference): FG+EXP (669.5 ±107.7)^A; FG (620.7 ±59.2)^A; EXP (506.5 ±27.0)^B; FG+RC (452.7 ±81.6)^B. No differences were found for failure mode (P=.595).

CONCLUSIONS

The experimental composite resin significantly increases fracture load when used to reline commercially available fiber posts and, irrespective of its use, presented lower stress concentration.

Effect of Fabrication Technique and Thermal Cycling on the Bond Strength of CAD/CAM Milled Custom Fit Anatomical Post and Cores: An In Vitro Study

PURPOSE

This study is to investigate the effect of milling custom fit anatomical post and cores from fiber reinforced composite and high-density polymer blocks using CAD/CAM technology on the bond strength to root canal dentin compared with prefabricated fiber posts, and to evaluate the influence of thermal cycling on the push out bond strength of the tested materials.

MATERIALS AND METHODS

Eighty extracted single-rooted premolars, endodontically treated and prepared to receive the posts, were randomly divided into four groups (n = 20): BLC: Custom-milled fiber-reinforced composite posts and cores (Trilor, Bioloren), AMC: Custom-milled high-density polymer posts and cores (Ambarino, Creamed), BLP: Prefabricated fiber-reinforced composite posts and composite core buildups (Bioloren; Filtek Bulk Fill Posterior, 3M). The posts used have the same matrix and fiber composition as BLC, RXP: Prefabricated posts and composite core buildups (RelyX fiber post, 3M; Filtek Bulk Fill Posterior); used as a control group. All of the posts were cemented using a self-adhesive resin cement (RelyX U200, 3M). Half of the sample was randomly assigned to thermal cycling in distilled water for 6,000 cycles to simulate aging, while the other half was tested for bond strength without thermal cycling. A push-out test was conducted using a universal testing machine until failure. Bond strength values were calculated in megapascals (MPa). The mode of failure was observed using a stereo microscope. Results were analyzed by two-way ANOVA followed by a Bonferroni post hoc test for comparison. The level of significance was set at p < 0.05.

RESULTS

Push-out bond strength was significantly higher (p <0.001) in the CAD/CAM post groups than in the groups with prefabricated posts regardless of the post material, while aging of the teeth did not significantly affect the push-out strength (p = 0.536). Failures were adhesive between cement and dentin for all groups except for AMC, where adhesive failure between the cement and the post was also observed.

CONCLUSION

The CAD/CAM manufacturing technique was proved to ameliorate the retention of the post and cores in the root canal. Thermal cycling did not affect the bond strength of the tested groups.

Comparison of the Effect for Fracture Resistance of Different Coronally Extended Post Length with Two Different Post Materials

Aims and Objectives:

To compare the effect for fracture resistance of different coronally extended post length with two different post materials.

Materials and Methods:

One hundred and sixty endodontically treated maxillary central incisors embedded in acrylic resin with decoronated root portion were taken for the study. The postspaces were prepared according to standard protocol. The samples were divided into two groups according to the post material: glass-fiber post and Quartz fiber post. These groups were further subdivided on the basis of coronal extension of 4 and 6 mm for glass fiber and Quartz fiber posts, respectively. The posts were then luted with dual-polymerizing resin cement followed by core buildup. Samples were subjected to increasing compressive oblique load until fracture occurred in a universal testing machine. Data were analyzed with one-way ANOVA and independent Student's t-test. Analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program.

Results:

Glass fiber post with coronal extension of 4 mm (182.8 N) showed better results than with 6-mm length (124.1 N). Similarly, in quartz fiber posts group, 4-mm postlength (314 N) was better when compared with 6 mm (160 N). The 4-mm coronal extension of quartz fiber post displayed superior fracture resistance.

Conclusions:

Glass fiber posts showed better fracture resistance than Quartz fiber posts. 4-mm coronal length showed more fracture resistance than 6 mm.

Effect of Load Cycling on the Fracture Strength/Mode of Teeth Restored with FRC Posts or a FRC Liner and a Resin Composite

The aim of the study was to comparatively evaluate the fracture strength and mode of root canal treated teeth restored with resin composites with and without posts. The lingual cusps of root canal treated first upper premolars (n = 10/group) were removed down to cervical enamel and restored with the following: group A: glass-fiber post (Glassix) followed by a particulate-filled composite resin (PFC, G-aenial posterior, 3 × 2 mm layers); group B: glass-fiber reinforced composite bulk fill liner (EverX posterior, 4 mm layer) with the PFC (2 mm layer). Specimens were immersed in H2O (1 w/37°C), then subjected to load cycling (50 N/0.2 Hz/200k cycles), and fractured under compressive loading. Failure mode was characterized by stereomicroscopy. Statistical analysis was performed by Mann-Whitney (load) and Chi-square (mode) at a = 0.05. No statistically significant differences (p = 0.273) were found in fracture load between median values of groups A (860 N) and B (1059 N). In group A, 60% of the specimens demonstrated catastrophic root fractures and 40% mixed crown fractures (tooth cusp and restoration), whereas in group B, no root fractures were found, and the failure modes were equally distributed between mixed fractures as above and fracture of the buccal cusp. These differences were statistically significant (p = 0.004). The combination of the glass-FRC bulk fill liner with the PFC diminished the catastrophic root fractures induced by FRC posts, at a similar or higher fracture load.

Effect of fiber post length and abutment height on fracture resistance of endodontically treated premolars prepared for zirconia crowns

The purpose of this study was to compare the fracture resistance, mode of fracture, and stress distribution of endodontically treated teeth prepared with three different fiber post lengths and two different abutment heights, using both experimental and finite element (FE) approaches. Forty-eight human maxillary premolars with two roots were selected and endodontically treated. The teeth were randomly distributed into six equally sized groups (n = 8) with different combinations of post lengths (7.5, 11, and 15 mm) and abutment heights (3 and 5 mm). All the teeth restored with glass fiber post (Rely X Fiber Post, 3M ESPE, USA) and a full zirconia crown. All the specimens were thermocycled and then loaded to failure at an oblique angle of 135°. Statistical analysis was performed for the effects of post length and abutment height on failure loads using ANOVA and Tukey's honestly significant difference test. In addition, corresponding FE models of a premolar restored with a glass fiber post were developed to examine mechanical responses. The factor of post length (P < 0.01) had a significant effect on failure load. The abutment height (P > 0.05) did not have a significant effect on failure load. The highest mean fracture resistance was recorded for the 15 mm post length and 5 mm abutment height test group, which was significantly more resistant to fracture than the 7.5 mm post and 5 mm abutment height group (P < 0.05). The FE analysis showed the peak compression and tension stress values of 7.5 mm post length were higher than that of 11 and 15 mm post length. The stress value of remaining tooth decreased as the post length was increased. Within the limitations of this experimental and FE analysis study, increasing the post length inside the root of endodontically treated premolar teeth restored with glass-fiber posts increase the fracture resistance to non-axial forces. Failure mode is more favorable with reduced abutment heights.

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).

Survival of extensively damaged endodontically treated incisors restored with different types of posts-and-core foundation restoration material

STATEMENT OF PROBLEM

Which post-and-core combination will best improve the performance of extensively damaged endodontically treated incisors without a ferrule is still unclear.

PURPOSE

The purpose of this in vitro study was to investigate the restoration of extensively damaged endodontically treated incisors without a ferrule using glass-ceramic crowns bonded to various composite resin foundation restorations and 2 types of posts.

MATERIAL AND METHODS

Sixty decoronated endodontically treated bovine incisors without a ferrule were divided into 4 groups and restored with various post-and-core foundation restorations. NfPfB=no-ferrule (Nf) with glass-fiber post (Pf) and bulk-fill resin foundation restoration (B); NfPfP=no-ferrule (Nf) with glass-fiber post (Pf) and dual-polymerized composite resin core foundation restoration (P); NfPt=no-ferrule (Nf) with titanium post (Pt) and resin core foundation restoration; and NfPtB=no-ferrule (Nf) with titanium post (Pt) and bulk-fill resin core foundation restoration (B). Two additional groups from previously published data from the same authors (FPf=2mm of ferrule (F) and glass-fiber post (Pf) and composite resin core foundation restoration; and NfPf=no-ferrule (Nf) with glass-fiber post (Pf) and composite resin core foundation restoration), which were tested concomitantly and using the same experimental arrangement, were included for comparison. All teeth were prepared to receive bonded glass-ceramic crowns luted with dual-polymerized resin cement and were subjected to accelerated fatigue testing under submerged conditions at room temperature. Cyclic isometric loading was applied to the incisal edge at an angle of 30 degrees with a frequency of 5 Hz, beginning with a load of 100 N (5000 cycles). A 100-N load increase was applied every 15000 cycles. The specimens were loaded until failure or to a maximum of 1000 N (140000 cycles). The 6 groups (4 groups from the present study and 2 groups from the previously published study) were compared using the Kaplan-Meier survival analysis (log-rank post hoc test at α=.05 for pairwise comparisons).

RESULTS

None of the tested specimen withstood all 140 000 cycles. All specimens without a ferrule were affected by an initial failure phenomenon (wide gap at the lingual margin between the core foundation restoration/crown assembly and the root). NfPfP, NfPt, and NfPtB had similar survival (29649 to 30987 mean cycles until initial failure). NfPfB outperformed NfPt and NfPtB. None of the post-and-core foundation restoration materials were able to match the performance of the ferrule group FPf (72667 cycles). In all groups, 100% of failures were catastrophic.

CONCLUSIONS

The survival of extensively damaged endodontically treated incisors without a ferrule was slightly improved by the use of a fiber post with a bulk-fill composite resin core foundation restoration. However, none of the post-and-core techniques was able to compensate for the absence of a ferrule. The presence of the posts always adversely affected the failure mode.

Strength comparison of anterior teeth restored with ceramic endocrowns vs custom-made post and cores

PURPOSE

The aim of the study was to compare strength of the anterior teeth restored with ceramic endocrowns versus custom-made post and core.

METHODS

The investigation used the finite element analysis. Three 3-D models of maxillary central incisor were created: model A-tooth restored with metal post and core with ceramic crown; model B-tooth with leucite ceramic endocrown; model C-tooth with lithium disilicate ceramic endocrown. Each model was subjected to a 100N force applied at a distance of 5mm from the incisal edge, at the angle of 130° to the long axis of the tooth. The modified von Mises failure criterion was used to evaluate the strength of the dentin, ceramic and resin cement, and Huber-Mises-Hencky failure criterion for cast alloy. Contact stresses in the cement-tissue adhesive interface were calculated.

RESULTS

The lowest stresses occurred in the anterior tooth restored with custom post and core (model A). The mvM stress of 47.5MPa concentrated in leucite ceramic endocrown (model B) and its value was close to the tensile strength of this material. The maximal mvM stresses in the lithium disilicate ceramic endocrown (model C) were 4 times lower than tensile strength of this material. In all cases contact stresses in the adhesive interface under restorations did not exceed the resin cement bond strength to dentin.

CONCLUSIONS

Leucite ceramic endocrowns in incisors may fracture during physiological loading. Endocrowns made of lithium disilicate ceramic are resistant to failure. Posts and prosthetic crowns are still recommended for anterior teeth restorations.

Relined Fiberglass Post: Effect of Luting Length, Resin Cement, and Cyclic Loading on the Bond to Weakened Root Dentin

This study evaluated the effects of luting length of the post, the resin cement, and cyclic loading on pull-out bond strength of fiberglass posts relined with composite resin in weakened roots. The canals of 80 bovine incisors were endodontically treated and weakened with diamond burs. The teeth were randomly divided into eight groups (n=10) according to the luting procedures of the relined fiberglass post (RFP): In groups 1, 2, 3, and 4, the RFPs were luted with RelyX ARC, and in groups 5, 6, 7, and 8 they were luted with RelyX U200. In groups 1, 3, 5, and 7, the RFPs were luted at a length of 5 mm, and in groups 2, 4, 6, and 8 they were luted at a length of 10 mm. Specimens from groups 3, 4, 7, and 8 were submitted to cyclic loading. Specimens were subjected to a pull-out bond strength test in a universal testing machine. The results (MPa) were analyzed by three-way analysis of variance and the Tukey post hoc test (α=0.05). Six human upper anterior teeth were used to analyze the bond interface by confocal laser scanning microscopy (CLSM). The pull-out bond strength of RFPs luted with RelyX U200 was statistically higher than that of RelyX ARC. Cyclic loading influenced the bond strength only for the luting length of 5 mm. CLSM analysis revealed the formation of resin cement tags for both materials. Luting length is an important factor in retaining RFPs in weakened roots when they are subjected to cyclic loading, and RelyX U200 resulted in greater bond strengths to the root canal in comparison with RelyX ARC.

Comparative evaluation of the effect of different crown ferrule designs on the fracture resistance of endodontically treated mandibular premolars restored with fiber posts, composite cores, and crowns: An ex-vivo study

INTRODUCTION

In cases of severe hard tissue loss, 2 mm circumferential ferrule is difficult to achieve which leads to incorporation of different ferrule designs.

AIM

To compare and evaluate the effect of different crown ferrule designs on the fracture resistance of mandibular premolars restored with fiber posts, composite cores, and crowns.

MATERIALS AND METHODS

Fifty freshly extracted mandibular premolars were endodontically treated and divided into five groups: Group I - 2 mm circumferential ferrule above the cementoenamel junction (CEJ); Group II - 2 mm ferrule on the facial aspect above CEJ; Group III - 2 mm ferrule on the lingual aspect above CEJ; Group IV - 2 mm ferrule on the facial and lingual aspects above CEJ with interproximal concavities, and Group V - no ferrule (control group) and were later restored with fiber posts, composite cores, and crowns. Specimens were mounted on a universal testing machine, and compressive load was applied at a crosshead speed of 1 mm/min until fracture occurred.

RESULTS

The results showed that circumferential ferrule produced the highest mean fracture resistance and the least fracture resistance was found in the control group.

CONCLUSION

Circumferential ferrule increases the fracture resistance of endodontically treated teeth restored with bonded post, core, and crown.

Inclusion of the periodontal ligament in studies on the biomechanical behavior of fiber post-retained restorations: An in vitro study and three-dimensional finite element analysis

Endodontically treated teeth are known to have reduced structural strength. Periodontal ligament may influence fracture resistance. The purpose of this study was to assess the influence of including the periodontal ligament in biomechanical studies about endodontically treated and restored teeth. Forty human maxillary central incisors were treated endodontically and randomly divided into four groups: non-crowned (with and without an artificial ligament) and crowned (with and without an artificial ligament) with glass-ceramic crowns. All groups received prefabricated glass-fiber posts and a composite resin core. Specimens were tested, under a flexural-compressive load, until failure occurred. The failure mode was registered for all specimens. The failure loads were recorded and analyzed using an analysis of variance test (p < 0.05). These results were compared with those predicted by a finite element model. The analysis of variance did not show significant differences between the use of crown on the failure load (p = 0.331) and the use of periodontal ligament (p = 0.185). A cohesive mode in crown appeared in crowned teeth and in core in non-crowned groups. For non-crowned teeth, adhesive failure occurred along the cement-enamel junction with a slight tendency in specimens without periodontal ligament. Furthermore, an unfavorable failure mode affects partially the root with no differences regarding non-crown specimens. In crowned teeth, the tendency was an adhesive failure along the cement-enamel junction. The model predicted a distribution of the safety factor consistent with these results. This study showed that inclusion of periodontal ligament is not particularly important on biomechanical behavior of post-retained restorations. However, we recommend its inclusion in fatigue studies.

Influence of periodontal ligament simulation on bond strength and fracture resistance of roots restored with fiber posts

Objective

Considering that periodontal ligament simulation may influence the stress distribution over teeth restored with intraradicular retainers, this study aimed to assess the combined effect of mechanical cycling and periodontal ligament simulation on both the bond strength between fiber posts and root dentin and the fracture resistance of teeth restored using glass fiber posts.

Material and Methods

Ninety roots were randomly distributed into 3 groups (n=10) (C-MC: control; P-MC: polyether; AS-MC: addition silicone) to test bond strength and 6 groups (n=10) (C: control; P: polyether; AS: addition silicone, without mechanical cycling, and C-MC, P-MC and AS-MC with mechanical cycling) to test fracture strength, according to the material used to simulate the periodontal ligament. For the bond strength test, fiber posts were cemented, cores were built, mechanical cycling was applied (2×106 cycles, 88 N, 2.2 Hz, and 45º incline), and the teeth cut into 3 slices (2 mm), which were then subjected to the push-out test at 1 mm/min. For the fracture strength test, fiber posts were cemented, cores were built, and half of the groups received mechanical cycling, followed by the compressive strength (45° to the long axis and 1 mm/min) performed on all groups.

Results

Periodontal ligament simulation did not affect the bond strength (p=0.244) between post and dentin. Simulation of periodontal ligament (p=0.153) and application of mechanical cycling (p=0.97) did not affect fracture resistance.

Conclusions

The materials used to simulate the periodontal ligament did not affect fracture or bond strength, therefore periodontal ligament simulation using the tested materials could be considered optional in the conditions of the study.

Fracture resistance of endodontically treated teeth using fiber post with an elastic modulus similar to dentin

This study investigated the effect of fiber reinforced composite resin (FRC) post lengths, ferrule, and full coverage metal crown on fracture resistance of endodontically treated teeth (ETT) using an experimental FRC post with the similar elastic modulus of dentin (11.5 GPa). ETT was restored according to 1 of 7 combinations of FRC post length (10, 5, 2.5, 0 mm), ferrule (0, 2 mm), and with/without metal crown (n=6). An oblique compressive load was applied on the restored teeth using a universal testing machine. Fracture loads were evaluated with 1-way ANOVA and Tukey HSD test (p<0.05). Compared with tooth preparation only, the fracture loads of ETT restored with composite resin and different post lengths were not significantly different. The group with the ferrule with metal crown showed significantly greater fracture resistance than the others.

Photoelastic stress analysis of endodontically treated teeth restored with different post systems: normal and alveolar bone resorption cases

The present study examined the influence of different post materials and their lengths on the mechanical stress of endodontically treated incisor roots in two alveolar bone conditions. Two-dimensional photoelastic models were fabricated to simulate the endodontically treated maxillary central incisors restored with three kinds of posts materials (low Young's modulus glass fiber post, high Young's modulus glass fiber post, and prefabricated stainless steel post) and two post lengths (8 and 4 mm). Completed models were placed in a transmission polariscope and loaded with a static force of 150 N at 45° to the tooth axis. Photoelastic photographs and the magnitudes of fringe order revealed stress distribution in the root, and suggest that the glass fiber post with a low Young's modulus and long length can reduce the stress concentration both in normal and alveolar bone resorption conditions.

Experimental strength of restorations with fibre posts at different stages, with and without using a simulated ligament

The aim of this study was to analyse the strength and failure mode of teeth restored with fibre posts under retention and flexural-compressive loads at different stages of the restoration and to analyse whether including a simulated ligament in the experimental setup has any effect on the strength or the failure mode. Thirty human maxillary central incisors were distributed in three different groups to be restored with simulation of different restoration stages (1: only post, 2: post and core, 3: post-core and crown), using Rebilda fibre posts. The specimens were inserted in resin blocks and loaded by means of a universal testing machine until failure under tension (stage 1) and 50º flexion (stages 2-3). Half the specimens in each group were restored using a simulated ligament between root dentine and resin block and the other half did not use this element. Failure in stage 1 always occurred at the post-dentine interface, with a mean failure load of 191·2 N. Failure in stage 2 was located mainly in the core or coronal dentine (mean failure load of 505·9 N). Failure in stage 3 was observed in the coronal dentine (mean failure load 397·4 N). Failure loads registered were greater than expected masticatory loads. Fracture modes were mostly reparable, thus indicating that this post is clinically valid at the different stages of restoration studied. The inclusion of the simulated ligament in the experimental system did not show a statistically significant effect on the failure load or the failure mode.

Effect of post length and diameter on remaining dentine thickness in maxillary central and lateral incisors

AIM

To investigate the effect of root canal and post-space preparation on the remaining dentine thickness in the apical region of maxillary central and lateral incisors.

METHODOLOGY

Fifty extracted maxillary incisors (25 centrals and 25 laterals) were mounted and then sectioned at two levels: 5 and 7 mm from the apex. Computerized images were obtained and a digital image analysis system was used to measure dentine thickness for each section at eight sites: labial, mesial, distal, palatal, mesio-labial, disto-labial, mesio-palatal and disto-palatal. Measurements were repeated at baseline and after both root canal and post-space preparation. Central and lateral incisors were divided into five groups each (n = 5) according to the drill used for post-space preparation: Groups 1 through 4 were prepared using Parapost drills sizes 4.5, 5, 5.5 and 6 respectively. For group 5, size 4 Gates Glidden was used.

RESULTS

For both teeth, and at the two levels there was a significant difference (P < 0.001) between the baseline dentine thickness and that remaining after post-space preparation at all sites. There was a statistically significant difference (P = 0.007) between the remaining dentine thickness at 5 and 7 mm at all sites. The average amount of dentine removed ranged from 0.20 to 0.52 mm. In all groups, and for both teeth, some specimens had <1 mm of remaining dentine thickness.

CONCLUSIONS

Posts should be used carefully when restoring root filled maxillary incisors.