Influence of ferrule preparation with or without glass fiber post on fracture resistance of endodontically treated teeth

Clinical and laboratorial performance of rehabilitation of endodontically treated teeth: A systematic review

OBJECTIVE

This systematic review aimed to analyze the clinical (survival rate, failure risk, or fracture) and laboratory performance (fracture mode or failure) of rehabilitations of endodontically treated teeth, with and without posts.

MATERIALS AND METHODS

A systematic search was conducted in the Pubmed, Scopus, Web of Science, Embase, Cochrane Library, and OpenGrey databases up to March 2023, according to PRISMA guidelines. In vitro and clinical studies that compared the clinical and laboratory performance of endodontically treated teeth with and without intraradicular posts were included. Studies selection, data extraction, and risk of bias analysis were performed.

RESULTS

Thirty-one in vitro and 7 clinical studies were included. For in vitro studies, fiberglass post (n = 24) was the most mentioned. The follow-up time of the clinical studies ranged from 1 to 17 years, with the fiber-reinforced composite post (n = 3) being the most evaluated, and only failure risk proved to be more favorable for using intraradicular posts.

CONCLUSION

Rehabilitations of endodontically treated teeth with and without intraradicular retainers showed no difference in fracture resistance and failure mode, evaluated by in vitro studies. Clinical studies showed no difference in survival rate, but failure risk proved to be more favorable for the use of posts.

CLINICAL SIGNIFICANCE

This analysis revealed significant variability between results, however, most laboratory and clinical studies revealed no difference with using the post. Furthermore, it is important to emphasize the need to evaluate the coronary remnant and the general characteristics of the tooth in each situation.

The Effect of Ferrule/Crown Ratio and Post Length on the Applied Stress and Strain Distribution to the Endodontically Treated Maxillary Central Teeth: A Finite Element Analysis

Objectives: One of the most common methods used for the reconstruction of endodontically treated teeth is post and core and crown. Various factors such as the remaining tissue above the cutting margin (ferrule) affect the fracture resistance of teeth restored with post and core and crown. This study aimed to investigate the effect of ferrule/crown ratio (FCR) on the strength of maxillary anterior central teeth using finite element analysis. Materials and Methods: A 3D scan of a central incisor was obtained, and the data were transferred to Mimics software. Then, a 3D model of the tooth was designed. Next, 300N load was applied at a 135° angle to the tooth model. Force was applied to the model both horizontally and vertically. Ferrule height was considered to be 5%, 10%, 15%, 20%, and 25% in the palatal surface and 50% in the buccal surface. The length of post in the model was 11, 13, and 15mm. Results: By increasing the FCR, stress and strain distribution increased in the dental model and decreased in the post itself. As the horizontal angle of load application increased, the level of stress and strain created in the dental model increased as well. The closer the force application site to the incisal area, the higher the stress and strain would be. Conclusion: Maximum stress was inversely correlated with FCR and post length. In ratios of 20% and higher, insignificant changes occurred in stress and strain patterns in the dental model.

The Influence of Dentin Wall Thickness and Adhesive Surface in Post and Core Crown and Endocrown Restorations on Central and Lateral Incisors

CLINICAL RELEVANCE

Post and core crowns and endocrowns perform similarly on fracture strength, but endocrowns have more repairable fractures.

SUMMARY

Effect of intraradicular fiber post on the fracture resistance of endodontically treated and restored anterior teeth: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A fiber post is indicated when there is a significant loss of tooth structure and additional support for the restoration is needed. However, whether the use of a glass fiber post affects the fracture susceptibility of the restored anterior teeth is unknown.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the fracture resistance of endodontically treated and restored anterior teeth and to answer the research question, "Does the use of a fiber post influence the fracture resistance of endodontically treated and restored anterior teeth compared with alternative restorative treatments?"

MATERIAL AND METHODS

A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and Embase databases without date and/or language restrictions (updated in July, 2020). In vitro studies comparing the fracture strength of endodontically treated and restored anterior teeth with and without fiber posts were included. The risk of bias was evaluated by using the previous meta-analyses of in vitro studies. The results were presented as standardized mean difference with a 95% confidence interval. Statistical heterogeneity of treatment effects between studies was assessed using the Cochran Q test and the I2 inconsistency test, and values greater than 50% were considered indicative of substantial heterogeneity.

RESULTS

After the removal of duplicates and title and abstract screening, 31 studies remained. Seventeen were considered low risk of bias, 10 were medium risk of bias, and 4 were high risk of bias. Meta-analysis comparing control and experimental groups favored the use of a fiber post in endodontically treated teeth with some types of restoration to improve fracture resistance (standardized mean difference= 0.5 [0.08; 0.92]); a glass fiber post was also favored (standardized mean difference=0.92 [0.43; 1.42]); for veneer preparations and teeth with cervical cavities, a fiber post increases the fracture strength (standardized mean difference= 0.74 [0.01; 1.47]; 1.18 [0.35; 2.02], respectively).

CONCLUSIONS

The use of glass fiber posts increases the fracture resistance of endodontically treated and restored teeth.

Effect of restorative treatment with endocrown and ferrule on the mechanical behavior of anterior endodontically treated teeth: An in vitro analysis

This study evaluated the effect of endocrown and ferrule restorative treatment on the mechanical behavior of anterior endodontically treated teeth. Human canines were treated endodontically and distributed in five groups (n = 10): sound teeth (S), crown associated with glass fiber post (GFP) and ferrule (GFP_f+) and that without ferrule (GFP_f-), and endocrown with ferrule (E_f+) and that without ferrule (E_f-). The crowns were obtained in lithium disilicate-based glass ceramic and cemented with resin. Thermomechanical loading (TL) was performed with progressive load of 80, 120, 160, 200, 240, 280, and 320 N with 20,000 cycles each, 140,000 cycles in total, frequency of 5 Hz, and temperature variation of 5°C-55 °C, followed by fracture resistance testing with load cell of 1000 Kgf and crosshead speed of 0.5 mm/min in a universal testing machine. Failure mode has been evaluated. Data were compared by Kaplan-Meier survival analysis (p < 0.05) for TL and one-way ANOVA and Tukey's test (p < 0.05) for fracture resistance. TL showed higher number of fractures for groups without ferrule (GFP_f- = 7, GFP_f+ = 3, E_f- = 10, and E_f+ = 2) and lower mean fracture load probability (GFP_f+ = 300 N, GFP_f- = 280 N, E_f+ = 320 N, E_f- = 188 N) than those with ferrule. Regarding fracture, teeth rehabilitated with GFP were more resistant to endocrowns with ferrule (p < 0.05). A higher percentage of type III failures after fatigue and type II failures after fracture were found. In conclusion, rehabilitation using GFP with ferrule is more favorable for anterior teeth, but the use of endocrown with ferrule proved feasible.

Does ferrule thickness influence resistance to fracture of endodontically treated teeth?

Background:

Teeth with severe crown destruction and endodontically treated may or may not present a circular strip of dental tissue located in the cervical region called ferrule.

Aims:

The aims of this study were to evaluate ferrule thickness influence on endodontically treated teeth (ETT) resistance to fracture.

Materials and Methods:

A total of 30 bovine incisor teeth were selected, endodontically treated and randomly distributed, according to the ferrule thickness: G1- no ferrule, G2 – 1 mm, and G3 – 2 mm. All the teeth were restored with prefabricated posts and composite resin. Resistance to fracture was established as the compression strength at 45° tilt at the lingual surface of the crown.

Statistical Analysis Used:

Data were analyzed using ANOVA and Tukey's test.

Results:

Resistance to fracture of G1 and G2 were significantly higher than that of G3 (P < 0.001). The pattern of fracture, common to all groups, occurred at the composite resin on the coronary portions.

Conclusion:

Ferrule thickness can influence the resistance to fracture of ETT.

In Vitro Fracture Strength of Teeth Restored with Lithium Disilicate Onlays with and without Fiber Post Build-Up

To our knowledge there is no data about the mechanical performance of indirect restoration adhesively cemented on teeth without an adequate build-up to provide the correct geometrical configuration. The aim of this study was to compare the fracture strength of human teeth restored with lithium disilicate onlays, with and without fiber post build-up.

METHODS

Twenty human mandibular molars were horizontally sectioned and divided into two groups (n = 10). No treatment was applied in group A. Teeth in group B were endodontically treated, built-up using fiber post and composite core and prepared with a circumferential chamfer providing a 1 mm circumferential ferrule. Lithium disilicate onlays were pressed and luted on teeth using dual-curing luting composite. Teeth were tested under static load. Failures were classified as restorable or not restorable. Failure loads were analyzed with one-way analysis of variance. Failure modes were compared using Pearson's Chi-square tests.

RESULTS

The mean fracture loads were 1383.5 N for group A and 1286.3 N for group B. No difference was found (p = 0.6). Ninety per cent of fractures were classified as not restorable in both groups, with no difference (p = 0.8).

CONCLUSIONS

For teeth restored with adhesive procedures and lithium disilicate onlays, the presence of build-up with fiber post to provide retention and resistance form does not influence the fracture strength.

Pino de fibra de vidro anatômico: relato de caso

Introdução: Pinos pré-fabricados de fibra de vidro possuem boas propriedades mecânicas e estéticas. Porém, estes podem não se adaptar bem em canais amplos ou excessivamente cônicos, prejudicando sua retenção ao canal radicular. Uma alternativa para esta desvantagem é a utilização da técnica de pino anatômico. Objetivo: O objetivo do relato de caso foi apresentar a técnica de confecção de um pino fibra de vidro anatômico em dente anterior, com reduzido remanescente coronário e ampla embocadura do canal radicular. Relato de Caso: Paciente masculino, 49 anos, procurou atendimento odontológico com queixa da aparência estética de seus dentes anteriores superiores. Após remoção de uma coroa metalocerâmica e um pino-núcleo metálico fundido do elemento 12, foram confeccionados um pino de fibra de vidro anatômico, núcleo de preenchimento e coroa provisória. Foram realizadas as facetas em resina composta nos elementos 13, 11, 21, 22 e 23. Uma coroa de cerâmica reforçada por dissilicato de lítio (IPS e.max CAD, Ivoclar Vivadent) foi cimentada no elemento 12. Conclusões: Através da técnica pino de fibra de vidro anatômico, é possível reabilitar dentes anteriores tratados endodonticamente sem a utilização de pinos metálicos, apresentando bons resultados estéticos. Entretanto, uma condição oclusal dentro dos princípios de uma oclusão mutuamente protegida deve ser almejada para garantir longevidade da restauração.

FE analysis of conceptual hybrid composite endodontic post designs in anterior teeth

OBJECTIVES

To assess conceptual designs of dental posts consisting of polyetherimide (PEI) reinforced with carbon (C) and glass (G) glass fibers in endodontically treated anterior teeth.

METHODS

3D tessellated CAD and geometric models of endodontically treated anterior teeth were generated from Micro-CT scan images. Model C-G/PEI composite posts with different Young's moduli were analyzed by Finite Element (FE) methods post A (57.7GPa), post B (31.6GPa), post C (from 57.7 to 9.0GPa in the coronal-apical direction). A load of 50N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum principal stress distribution was determined along the post and at the interface between the post and the surrounding structure.

RESULTS

Post C, with Young's modulus decreasing from 57.7 to 9.0GPa in the coronal-apical direction, reduced the maximum principal stress distribution in the restored tooth. Post C gave reduced stress and the most uniform stress distribution with no stress concentration, compared to the other C-G/PEI composite posts.

SIGNIFICANCE

The FE analysis confirmed the ability of the functionally graded post to dissipate stress from the coronal to the apical end. Hence actual (physical) C-G/PEI posts could permit optimization of stress distributions in endodontically treated anterior teeth.

Influence of elastic modulus of intraradicular posts on the fracture load of roots restored with full crowns

Abstract Objective This study aimed to evaluate the fracture load and displacement of roots restored with posts of different elastic modulus. Material and method Thirty-six replicas of epoxy resin mixed with glass microfibers were made from an endodontically-treated human premolar root prepared to a length of 12 mm with a custom drill, leaving the apical 4 mm unprepared. Replicas were randomly restored with (n = 12): FP-LM (fiber post with low elastic modulus– 50 GPa), FP-HM (fiber post with high elastic modulus – 67 GPa) and MP (metallic post – 208 GPa), using self-curing adhesive and dual resin cement. Cores were built up with composite resin and metallic crowns were cemented in all the roots with self-adhesive resin cement with self-curing mode. Specimens were subjected to a fracture load test (45° inclination/0.5 mm/min) and displacement was registered at 100 N. Result One-way ANOVA showed that elastic modulus of the post did not affect the fracture load means (p = 0.203) (FP-LM: 237.4 ± 65.11 N; FP-HM: 236.7 ± 92.85 N; MP: 295.8 ± 108.7 N) but was statistically significant for the displacement (p < 0.00): Tukey’s test showed that FP-LM displacement mean (0.81 ± 0.15 mm) was significantly higher than those for FP-HM (0.46 ± 0.26 mm; p = 0.00) and MP (0.62 ± 0.07 mm; p = 0.04). Conclusion Posts with different elastic modulus exhibit similar fracture loads, but a lower displacement is achieved when fiber posts with a high elastic modulus and metallic posts are used.

Effect of Different Ferrule Length on Fracture Resistance of Endodontically Treated Teeth: An In vitro Study

INTRODUCTION

A ferrule has been described as a key element of tooth preparation when using a post and a core. It is a vertical band of tooth structure at the gingival aspect of crown preparation. It lessens the stress transmission to the root which is due to forces from posts or bending during seating of the post. The incorporation of a ferrule can help to withstand the forces of occlusion, preserve the hermetic seal of the luting cement, and minimize the concentration of stresses at the junction of post and core.

AIM

To evaluate and compare the effect of ferrule length on fracture resistance of endodontically treated mandibular premolar teeth, restored with prefabricated glass fiber post luted with resin cement, composite core and a full coverage metal crown.

MATERIALS AND METHODS

Forty freshly extracted mandibular premolars were treated endodontically. They were randomly divided into four groups according to their ferrule height: 3 mm, 2 mm, 1 mm and 0 mm (no ferrule). All specimens were restored with prefabricated glass fibre posts (Reforpost, Angelus) and composite resin (Filtek™ Z250XT). Standardized preparation was done on each specimen to receive a cast metal crown. The specimens were thermocycled and compressive static load at a crosshead speed of 1 mm/min was applied at an angle of 30° on lingual incline of buccal cusp of the crown until failure occurred. The load (N) at failure and mode of failure were recorded. Statistical analysis was performed with Kruskal Wallis test.

RESULT

Fracture resistance values among the groups was found to be statistically significant (p<0.001). The 3 mm ferrule group had significantly higher failure load (971.99±133.07) compared to 2 mm (848.84±109.60), 1 mm (714.64±133.89) and 0 mm ferrule groups (529.36±119.95). More favourable failure modes were observed in almost all groups.

CONCLUSION

The results of this study showed that fracture resistance of endodontically treated teeth increases as ferrule length increases.

Ferrule-Effect Dominates Over Use of a Fiber Post When Restoring Endodontically Treated Incisors: An In Vitro Study

OBJECTIVES

 The aim of this study was to investigate the restoration of broken-down endodontically treated incisors with the ferrule effect using glass ceramic crowns bonded to composite resin core buildups with or without a fiber post. A no-ferrule group with post was also included for comparison.

METHODS AND MATERIALS

 Thirty decoronated endodontically treated bovine incisors with a 2-mm ferrule were restored with a direct buildup using a nanohybrid direct composite resin (Miris 2 and Optibond FL) with or without a glass-fiber-reinforced post. An additional group of 15 teeth without a ferrule were restored with buildup and a fiber post. All teeth were prepared to receive bonded glass ceramic crowns (e.max CAD luted with Variolink Esthetic DC) and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30° 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 of 1000 N (×140,000 cycles). Groups were compared using the Kaplan Meier survival analysis (log rank test at p=0.05).

RESULTS

 None of the tested specimens withstood all 140,000 load cycles. Specimens with posts but without a ferrule were affected by an initial failure phenomenon (wide gap at the lingual margin between the buildup/crown assembly and the root). There was a significant difference in mean survived cycles between the ferrule groups (Fp=73,332× and FNp=73,244×) and the no-ferrule group (50,121×; p=0.001). The addition of a fiber post was not significant in the presence of the ferrule (p=0.884). In both groups with posts, 100% of failures were unrestorable. The no-post group had 47% of restorable and possibly restorable failures.

CONCLUSIONS

 The survival of broken-down nonvital incisors was improved by the presence of the ferrule but not by the fiber-reinforced post. Fiber posts were always detrimental to the failure mode and were not able to compensate for the absence of a ferrule.

Fracture resistance of endodontically treated canines restored with different sizes of fiber post and all-ceramic crowns

PURPOSE

The aim of this study was to determine the fracture resistance and the mode of fracture of endodontically treated teeth restored with different fiber posts and all-ceramic crowns.

MATERIALS AND METHODS

Two glass fiber reinforced post systems in two different sizes and polyethylene fiber ribbon in two different thicknesses (n=10) were used. The specimens, restored with all-ceramic crowns, were subjected to a compressive load (in N) delivered at a 130-degree angle to the long axis until a fracture could be noted. The results were analyzed statistically with a One-Way ANOVA test (P<.05).

RESULTS

Statistically significant differences were observed between the mean fracture resistance values of Postec, Snowlight, and Kerr Connect thin specimens (P<.0095). The Postec results (395.70 N) were found to be significantly higher than the others. No statistical difference was observed among the thick specimens (P<.2657). The mean fracture resistance values of the Snowlight thick samples were found to be higher than those of the Snowlight thin samples. The specimens were always fractured around the cemento-enamel junction at the palatinal side. No post fracture was observed for the thin Snowlight and Kerr Connect specimens or for the thick Postec and Kerr Connect specimens. Among the common failure types of the specimens, the worst was observed to be the root fracture failure. The highest post dislodgement failure result (80%) was obtained from the thin Kerr Connect specimen.

CONCLUSION

In terms of optimizing fracture resistance, the fiber post size selection should be done according to the forces applied to the restored teeth.

Influence of Adhesive Core Buildup Designs on the Resistance of Endodontically Treated Molars Restored With Lithium Disilicate CAD/CAM Crowns

OBJECTIVE

To assess the influence of adhesive core buildup designs (4-mm buildup, 2-mm buildup, and no buildup/endocrown) on the fatigue resistance and failure mode of endodontically treated molar teeth restored with lithium disilicate computer-aided design/computer-aided manufacturing (CAD/CAM) complete crowns placed with self-adhesive cement.

METHODS AND MATERIALS

Forty-five extracted molars were decoronated at the level of the cementoenamel junction and endodontically treated. Specimens received different Filtek Z100 adhesive core buildups (4-mm buildup; 2-mm buildup; and no buildup endocrown preparation) and were restored with Cerec 3 CAD/CAM lithium disilicate crowns (IPS e.max CAD). The intaglio surfaces of restorations (n=15) were conditioned by hydrofluoric acid etching and silane, and prepared teeth were treated with airborne-particle abrasion, followed by cementation with RelyX Unicem 2 Automix. Specimens were then subjected to cyclic isometric loading at 10 Hz, beginning with a load of 200 N (×5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles. The chewing cycle was simulated by an isometric contraction (load control) applied through a 10-mm in diameter composite resin sphere (Filtek Z100). Surviving specimens were axially loaded until failure or to a maximum load of 4500 N (crosshead speed 0.5 mm/min). The failure mode was assessed, and fractures were designated as catastrophic (tooth/root fracture that would require tooth extraction) or reparable (cohesive or cohesive/adhesive fracture of restoration only). Groups were compared using the life table survival analysis (log-rank test at p=0.05). Surviving specimens were loaded to failure and compared with one-way analysis of variance.

RESULTS

The survival rates after the fatigue test were 100%, 93%, and 100% for 4-mm, 2-mm, and no buildup (endocrown), respectively and were not statistically different (only one specimen failed with a 2-mm buildup under a crown that cohesively fractured at 1,400 N). Postfatigue load to failure averaged 3181 N for 4-mm buildups (15 specimens), 3759 N for 2-mm buildups (12 specimens), and 3265 N for endocrowns (14 specimens). The 2-mm buildups were associated with higher loads to failure than endocrowns and 4-mm buildups, but no differences were found between 4-mm buildups and endocrowns (p<0.05.) One endocrown and 2 restorations with a 2-mm buildup survived the load-to-failure test (at 4500 N). Only catastrophic fractures occurred after the load-to-failure test.

CONCLUSIONS

The buildup design influenced the performance of endodontically treated molars restored with lithium disilicate CAD/CAM complete crowns placed with self-adhesive resin cement. The 2-mm buildups were associated with higher loads to failure than the endocrown and the 4-mm buildup, but all restoration designs survived far beyond the normal range of masticatory forces.

Influence of No-Ferrule and No-Post Buildup Design on the Fatigue Resistance of Endodontically Treated Molars Restored With Resin Nanoceramic CAD/CAM Crowns

Objectives

To evaluate the influence of adhesive core buildup designs—4-mm buildup, 2-mm buildup, and no buildup (endocrown)—on the fatigue resistance and failure mode of endodontically treated molar teeth restored with resin nanoceramic (RNC) CAD/CAM complete crowns placed with self-adhesive resin cement.

Methods and Materials

Forty-five extracted molars were decoronated at the level of the cementoenamel junction, and the roots were endodontically treated. Specimens received different Filtek Z100 adhesive core buildups (4-mm buildup, 2-mm buildup, and no buildup, endocrown preparation) and were restored with Cerec 3 CAD/CAM RNC crowns (Lava Ultimate). Restorations (n=15) and prepared teeth were treated with airborne-particle abrasion, followed by cementation with RelyX Unicem 2 Automix. Specimens were then subjected to cyclic isometric loading at 10 Hz, beginning with a load of 200 N (for 5000 cycles), followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30,000 cycles each. Specimens were loaded until failure or to a maximum of 185,000 cycles (10-mm-diameter composite resin sphere antagonist). The failure mode was assessed: “catastrophic” (tooth/root fracture that would require tooth extraction), “possibly reparable” (cohesive/adhesive failure with fragment and minor damage, chip or crack, of underlying tooth structure), or “reparable” fracture (cohesive or cohesive/adhesive fracture of restoration only). Groups were compared using the life table survival analysis. Intact specimens were loaded to failure and compared with one-way analysis of variance.

Results

All specimens survived the fatigue test until the 800 N-step. The survival rates for 4-mm, 2-mm, and no buildup (endocrown) were 53%, 87%, and 87%, respectively, and were not statistically different even though crowns with 2-mm buildups only started to fail at 1200 N. Minor cohesive chips were detected in many samples despite having survived all 185,000 cycles. Postfatigue load-to-failure ranged from 2969 N with 4-mm buildup (eight specimens), 2794 N for 2-mm buildup (13 specimens), and 2606 N for endocrowns (13 specimens) and were also not statistically different. There were only two catastrophic failures during the fatigue test and small subgingival delamination fractures and cracks (only with 4-mm buildup). All specimens in the load-to-failure test exhibited nonrestorable catastrophic fractures.

Conclusions

There was no influence of the buildup design on the performance of endodontically treated molars restored with RNC CAD/CAM complete crowns placed with self-adhesive cement. All restoration designs survived the normal range of masticatory forces. Failure mode tended to be more favorable with the 2-mm buildup or no buildup (endocrown).

A 3-dimensional finite element analysis of the restoration of the maxillary canine with a complex zirconia post system

STATEMENT OF PROBLEM

Zirconia posts exhibit high strength and toughness, but reliable bonding with the resin core is difficult to attain. The use of a ferrule has been found to improve stress distribution in the root of endodontically treated teeth.

PURPOSE

The purpose of this finite element analysis study was to measure the stress distribution in the post-core system and root structure of a maxillary canine.

MATERIAL AND METHODS

A right maxillary canine was embedded and subjected to a micro-computed tomography scan. Three-dimensional dynamic scan data were then transformed, and a finite element model of 4 dentin ferrule heights was designed with zirconia posts and heat-pressed glass ceramics for a complete crown restoration. Von Mises stresses were determined by applying a 300 N static load to the middle of the lingual surface of the crown.

RESULTS

When the ferrule height increased from 0 to 3 mm, the maximum von Mises stress of the zirconia post decreased from 196 to 149 MPa, and that on the zirconia post-dentin interface decreased from 174 to 132 MPa. The maximum von Mises stress decreased from 39.8 to 32.5 MPa in the apical root and from 59.5 to 49.9 MPa in the mid-root when the ferrule height increased from 0 to 3 mm.

CONCLUSIONS

Increased ferrule height is associated with reduced von Mises stress in the zirconia post and the post-dentin interface, with an apparent shift of von Mises stress to the root cervical area from the mid-root and the apex.

The effect of ferrule presence and type of dowel on fracture resistance of endodontically treated teeth restored with metal-ceramic crowns

AIM

The purpose of the present study was to comparatively evaluate the effect of presence of a 2 mm ferrule and different type of dowels on fracture resistance of mandibular premolars.

MATERIALS AND METHODS

Fifty uniradicular mandibular premolars were divided into five groups (n = 10). Ten teeth received no treatment (group I). Samples in group II & III were decoronated 2 mm above cemento-enamel junction and received custom cast dowel-core and fiber dowel-composite core respectively, with 2 mm ferrule. Samples in group IV & V were decoronated at CEJ and were restored using cast dowels and fiber dowel-composite cores, without any ferrule. The restored teeth received metal ceramic crowns and were mechanically loaded. The specimens were subjected to a static load, until fracture, to determine the fracture resistance and fracture mode.

RESULTS

The samples with 2 mm ferrule had a higher fracture resistance than non ferrule groups. Within non ferrule groups, there were no significant differences in the fracture resistance. Specimen restored with cast dowel had more incidence of non-repairable fracture.

CONCLUSIONS

Presence of ferrule increased the fracture resistance of endodontically treated teeth. In case of absence of ferrule, fiber dowels had similar fracture resistance as that of cast dowels and showed increased incidence of repairable fracture.

Four-year Survival of Endodontically Treated Premolars Restored with Fiber Posts

The objective of this prospective clinical trial was to investigate the influence of the residual coronal structure of endodontically treated teeth and the type of cement used for luting fiber posts on four-year clinical survival. Two groups (n = 60) were defined, depending on the amount of residual coronal dentin after abutment build-up and final preparation: (1) more than 50% of coronal residual structure; and (2) equal to or less than 50% of coronal residual structure. Within each group, teeth were randomly divided into 2 subgroups (n = 30) according to the material used for luting fiber posts: (A) resin core build-up material, Gradia Core; or (B) self-adhesive universal cement GCem Automix. The rate of success was assessed based on clinical and intra-oral radiographic examinations at the follow-up after 6, 12, 24, 36, and 48 months. The highest 48-month success and survival rates were recorded in group 1A (90% and 100%, respectively), whereas teeth in group 2B exhibited the lowest performance (63.3% success rate, 86.6% survival rate). Cox regression analysis revealed that neither the amount of coronal residual structure nor the luting material significantly influenced the failure risk (p > .05) (ClinicalTrials.gov, NCT01532947).

Influence of remaining coronal structure and of the marginal design on the fracture strength of roots restored with cast post and core

OBJECTIVE

The purpose of this study was to evaluate the fracture strength of roots that were prosthetically restored with cast post and core with or without any remaining coronal structure and with different finish lines.

MATERIALS AND METHODS

Sixty bovine incisors were sectioned below the cementoenamel junction, endodontically treated and randomly divided into six experimental groups (n = 10) containing teeth with or without any remaining coronal structure and with a beveled shoulder, a chanfered or a shoulder finish line design. The cast post and core were luted with dual-cured resin cement. The metal crowns were cemented with zinc phosphate cement. The specimens were subjected to a tangential compressive load (135° angle) at a crosshead speed of 0.5 mm/min until failure, using a universal testing machine. The fracture strength data were analyzed using the ANOVA and LSMeans (least square means) tests (α = 0.05).

RESULTS

The data indicated that the teeth with 2 mm of remaining coronal structure showed the highest fracture strength values when compared with the teeth without any remaining structure (p < 0.05). As to the different finish line designs, the highest fracture strength values were obtained for the beveled shoulder, followed by the chanfered and then by the shoulder designs (p < 0.05).

CONCLUSIONS

It may be concluded that, to increase fracture strength, a beveled shoulder and 2 mm of remaining coronal structure are the ideal conditions.

Effect of ferrule and post placement on fracture resistance of endodontically treated teeth after fatigue loading

OBJECTIVES

To evaluate the influence of the ferrule effect (1) and the fibre-post placement (2) on the fracture resistance of endodontically treated teeth subjected to cyclic fatigue loading.

METHODS

40 extracted single-rooted upper pre-molars were sectioned at the CEJ (groups a and b) or 2mm above the CEJ (groups c and d), and subsequently endodontically treated. After 24-h water storage at 37°C, specimens were restored according to four build-up approaches (n=10 per group): (a) NF-NP (no ferrule, no post), (b) NF-P (no ferrule, fibre-post), (c) F-NP (ferrule, no post) and (d) F-P (ferrule, fibre post). RelyX Posts (3M-ESPE) were used in groups NF-P and F-P, and were cemented with Panavia F 2.0 (Kuraray). A standardized composite core was built, after which specimens were restored with an all-ceramic crown (IPS Empress CAD, Ivoclar-Vivadent) Specimens were fatigued by exposure to 1,200,000 cycles using a chewing simulator (Willytech). All specimens that survived fatigue loading were fractured using a universal loading device (Micro-Tester, Instron). A two-way analysis of variance was used to determine the statistical significance of the factors ferrule and post on fracture resistance.

RESULTS

Only one NF-NP specimen failed under fatigue. The ferrule effect significantly enhanced the fracture resistance of the restored teeth, regardless the use of a post (p=0.003). F-NP obtained the highest fracture resistance (758.52±121.89N), which was not significantly different from F-P (647.58±132.95N); NF-NP presented the lowest fracture resistance (361.52±151.69N). For all groups, only 'repairable' failures were recorded.

CONCLUSIONS

Avoiding extra-removal of sound tooth structure, rather than placing a fibre post, can protect endodontically treated teeth against catastrophic failure. However, when any ferrule can be preserved, a fibre-post may improve the retention and fatigue resistance of the restoration.

Influence of remaining coronal structure and finish line on the fracture strength of roots restored with metallic posts

The purpose of this study was to evaluate the fracture strength of roots that were prosthetically restored with metallic posts with or without any remaining coronal structure and with different finish lines. Sixty bovine incisors were sectioned below the cementoenamel junction, endodontically treated, and randomly divided into six experimental groups (n = 10) containing teeth with or without any remaining coronal structure, and with a beveled shoulder, a bevel, or a shoulder finish line design. The metallic posts were luted with dual-cured resin cement. The cores were made with composite resin, and metal crowns were cemented with zinc phosphate cement. The specimens were subjected to a tangential compressive load (135º angle) at a crosshead speed of 0.5 mm/min until failure, using a universal testing machine. The fracture strength data were analyzed using the ANOVA and LSMeans (least square means) tests (α= 0.05). The data indicated that the teeth with 2 mm of remaining coronal structure showed the highest fracture strength values when compared with the teeth without any remaining structure (p < 0.05). As to the different finish line designs, the highest fracture strength values were obtained for the beveled shoulder, followed by the bevel and then by the shoulder designs (p < 0.05). It may be concluded that, to increase fracture strength, a beveled shoulder and 2 mm of remaining coronal structure are the ideal conditions.

Evaluation of the effect of different ferrule designs on fracture resistance of maxillary incisors restored with bonded posts and cores

INTRODUCTION

In cases of severe hard tissue loss, 2 mm circumferential ferrule is difficult to achieve. So in these cases we should use different ferrule designs. This in vitro study investigated the effect of different ferrule designs on the fracture resistance of teeth restored with bonded post and cores.

MATERIALS AND METHODS

Forty freshly-extracted central incisors were endodontically treated. The teeth were randomly divided into four groups; group 1 were teeth with 2 mm circumferential ferrule above the CEJ, group 2 were teeth with 2 mm ferrule only on the palatal side of the teeth, group 3 consisted of teeth with 2 mm ferrule only on the facial side and group 4 were teeth with 2 mm ferrule on the palatal and facial side of teeth with interproximal concavities. All teeth were restored with fiber posts and composite cores. The specimen was mounted on a universal testing machine and compressive load was applied to the long axis of the specimen until failure occurred.

RESULTS

The fracture resistance was 533.79 ± 232.28 in group 1, 634.75± 133.35 in group 2, 828.90 ±118.27 in group 3 and 678.78± 160.20 in group 4. The post hoc analysis showed statistically significant difference between groups 1 and 3.

CONCLUSIONS

The results of this in vitro study showed that facial ferrule increases the fracture resistance of endodontically treated teeth restored with bonded post and cores.