Fracture resistance of endodontically treated anterior teeth restored with four post-and-core systems.

OBJECTIVE: The purpose of this study was to evaluate the fracture resistance and the mode of failure of endodontically treated teeth restored with four post-and-core systems. METHOD AND MATERIALS: Forty intact human incisors were randomly divided into four groups. Teeth from each group received endodontic therapy and one of four post-and-core systems: serrated, parallel-sided, cast post and core; serrated, parallel-sided, prefabricated post and resin-composite core; carbon-fiber-reinforced (CFC) post and resin-composite core; and ceramic post and resin-composite core. A full-coverage metal crown was fabricated and cemented onto each tooth. Each specimen was subjected to a compressive load at a 45-degree angle to its axis until failure. The failure load was recorded and compared statistically. The mode of failure of the specimens was analyzed. RESULTS: There was no significant difference in the failure loads among groups. More catastrophic root fracture was detected in the group restored with ceramic posts and resin-composite cores. CONCLUSION: The fracture resistance of endodontically treated teeth restored with these four post-and-core systems could be accepted clinically. Unfavorable tooth fracture was shown in all groups.     

Fracture strength of endodontically treated teeth restored with different strategies after mechanical cycling

The aim of this study was to analyze the fracture strength of endodontically treated teeth with different coronal restoration strategies after mechanical cycling. Thirty bovine teeth were randomly allocated into three groups (n = 10): Group 1, cast metal post and core; Group 2, glass fiber post with a composite resin core; Group 3, glass fiber post with a glass prefabricated core. For post cementation, an etch and rinse multistep adhesive system and resin cement were used. The specimens were submitted to mechanical cycling (106 cycles, 90 N, 4 Hz, 37 ± 1 degree C) and immediately loaded in a universal testing machine. The statistical analysis (one-way ANOVA) did not indicate a significant difference among the tested groups (Group 1 = 593.9 ± 128.7 N; Group 2 = 554.4 ± 213.3 N; Group 3 = 427 ± 104.8 N; P = 0.06). With regard to fracture patterns, all Group 1 specimens demonstrated catastrophic failures, while the specimens in Groups 2 and 3 demonstrated core or core/post failure. Despite the similar fracture strength observed in the tested groups, teeth restored with composite resin or glass prefabricated cores demonstrated favorable failure patterns compared to the cast metal post and core group. This study demonstrates that a glass prefabricated core can be an acceptable alternative for the reconstruction of endodontically treated teeth.     

两种桩系统修复对根管治疗牙强度的影响

目的比较两种不同弹性模量的桩系统对根管治疗牙修复后强度的影响。方法20颗近期拔除的完整人上颌中切牙,根管治疗后随机分成两组,每组10颗。组一进行玻璃纤维桩ParaPost Fiber white(Coltene/ whaledent Inc)、复合树脂核及铸造全冠修复。组二进行铸造镍铬桩核及铸造全冠修复。每组牙均保留1.5mm的牙本质肩领(Ferrule)。实验标本包埋于自凝树脂块中,固定在DCS5000材料试验机上。加栽头以1mm/min的速度,与牙长轴成130°进行加载直至标本断裂。断裂强度采用独立样本t检验,断裂方式采用Fisher’s精确概率法(P <0.05)。结果组一断裂强度为43.406±18.959kg,组二33.680±9.675kg,差异无显著性(P>0.05)。可修复性断裂方式见于玻璃纤维桩核,而不可修复性的破坏多见于铸造镍铬桩核组(P<0.001)。结论在牙体预备保留1.5mm牙本质肩领(Ferrule)的情况下,两种不同弹性模量的桩对根管治疗牙桩核加全冠修复后的强度影响无差异,可修复性的破坏见于弹性模量与牙本质近似的玻璃纤维桩组。     

可塑纤维桩修复对根管治疗牙抗折强度的影响

目的比较不同桩修复离体牙对修复体整体抗折强度的影响。方法将32颗上颌前磨牙行根管治疗并从唇侧釉牙骨质界上2 mm处截断后随机分为4组,A组采用镍铬金属铸造桩核加铸造冠修复,B组采用Tenax FiberWhite纤维桩、树脂核加铸造冠修复,C组采用EverStick可塑纤维桩单根（直径1.5 mm）、树脂核加铸造冠修复,D组采用EverStick可塑纤维桩双根（直径1.5 mm和1.2 mm）、树脂核加铸造冠修复。所有离体牙均由自凝树脂包埋,电子万能试验机加载头与牙体长轴成45°,以1 mm/min的加载速度加载直至试件任何部分折裂,记录读数并观察修复体折裂模式。结果A、B、C、D组间修复体的整体抗折强度差异无统计学意义（P>0.05）。各纤维桩组牙体折裂位置较铸造桩更接近牙颈部。结论尽管可塑纤维桩自身的弯曲强度较低,但是修复离体牙后整体抗折强度较高,可以满足临床要求。各纤维桩组折裂模式较铸造桩组更有利于修复体失败后的再修复。     

Fracture resistance of endodontically treated teeth restored with three different prefabricated esthetic posts

Purpose: This study was undertaken to evaluate the role of composition of prefabricated esthetic posts in fracture resistance of endodontically treated teeth in vitro. Materials and Methods: Thirty human, single‐rooted teeth (maxillary central incisors and canines) with similar root dimensions, extracted for therapeutic reasons, were used in this study. The crowns were removed below the cementoenamel junction to obtain a standard root length of 17 mm. The roots were endodontically treated following the conventional manual technique and randomly assigned to three groups (n = 10) according to the post used: Aestheti‐Post, Bisco, Schaumberg, Illinois; FibreKor Post, Jeneric/Pentron, Wallingford, Connecticut; and CosmoPost, Ivoclar Vivadent, Schaan, Liechtenstein. The root canals were rendered patent, and the root preparations were standardized through flaring with the manufacturers' drills included in the respective kits. The posts were cemented with an adhesive system and a resin cement (All‐Bond 2 and C & B, Bisco, respectively), according to the manufacturers' directions. Composite resin (Tetric Ceram, Ivoclar Vivadent) crowns were built up using a preformed polyester matrix, and the specimens were mounted in metallic rings with cold‐cure acrylic resin and kept in saline solution at 4°C for 24 hours. Fracture resistance was then determined using an EMIC DL‐2000 universal testing machine. The crosshead speed was 0.5 mm/min with the 45‐degree compressing load at the middle third of the crown. Data were analyzed using one‐way analysis of variance and Tukey'stest (p<.001). Results: Mean fracture resistance was as follows: Aestheti‐Post, 83.5 kgf; FibreKor Post, 85.7 kgf; and CosmoPost, 36.5 kgf. The fracture strength of CosmoPost was significantly lower than that of the other posts. Teeth restored with CosmoPost had post fractures, and in three specimens, those were associated with root fractures. Teeth restored with the other two posts presented fractures on the composite crowns. CLINICAL SIGNIFICANCE Compared with ceramic posts, carbon‐fiber and glass‐fiber prefabricated esthetic posts provide endodontically treated teeth higher fracture resistance.     

Fracture resistance of endodontically treated teeth restored with composite posts

STATEMENT OF PROBLEM: The most recent application of fiber-reinforced composites involves their use as post and core systems to restore endodontically treated teeth. Even though this last application has been advertised and used clinically by many dentists, there is very little information regarding the physical properties of these post systems. PURPOSE: The purpose of this study was to compare the effect of 3 fiber-reinforced composite post systems on the fracture resistance and mode of failure of endodontically treated teeth. MATERIAL AND METHODS: Ninety maxillary central incisors were divided into 8 experimental groups and 1 stainless steel (ParaPost) control group of 10 specimens each. Eighty teeth were assigned to 2 main experimental groups called "narrow" and "flared" canals. For the narrow canal group, post spaces were prepared with the corresponding reamer to restore the teeth with FibreKor, Luscent anchors, and Ribbond posts of 1.5 mm, 1.6 mm, and 2.0 mm in diameter, respectively. For the flared canals group thin-walled canals were simulated. Teeth for the flared canals were restored with the same posts but were cemented into tapered 2 mm wide canals created with a tapered diamond bur. Prefabricated posts (FibreKor and Luscent anchors) for narrow and flared canals were cemented with an autopolymerized resin cement and a flowable composite, respectively, whereas customized Ribbond posts were luted with a light-polymerized flowable composite for both canal types. An additional set of 20 Ribbond posts with coronal portions of variable size and shape referred to as "Ribbond nonstandardized" were also prepared and evaluated. Specimens were loaded to failure (kg) with a universal testing machine at a crosshead speed of 0.05 cm/min until failure occurred. Data were analyzed with analysis of variance and Student t tests (P<.05). RESULTS: Statistical analysis revealed no significant difference between flared and narrow canals in mean load to failure between the post systems except for the Ribbond posts (P<.01). For the narrow canal, the mean load ranged from a low of 4.55 (+/-1.49) kg for the Ribbond standard to a high of 12.9 (+/-1.64) kg for the Luscent anchors. For the flared canal the low mean was 9.04 (+/-1.76) kg for FibreKor and the high was equal for both Luscent anchors and Ribbond standard, 12.87 (+/-2.69) and 12.87 (+/-3.54), respectively. Overall, the ParaPost control group had the highest load value (18.33 +/- 3.27 kg) (P<.05). Ribbond nonstandardized had a mean load to failure of 24.91 (+/-11.53) Kg for the narrow canal group and 31.95 (+/-11.98) kg for the flared canal. Results from these groups were excluded from the statistical analysis because of the uncontrolled core sizes and high standard deviations. No root fractures occurred in any of the experimental groups. CONCLUSION: Results from the study show that the load to failure of the stainless steel posts were significantly stronger than all the composite posts studied. However, the mode of failure or deflection of the fiber-reinforced composite posts is protective to the remaining tooth structure.     

Resistance to fracture of endodontically treated teeth restored with different post systems

STATEMENT OF PROBLEM: Very little is known about the resistance to fracture of endodontically treated teeth restored with newly developed esthetic post systems. Purpose. This in vitro study compared the effect of 1 titanium and 3 esthetic post systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth. MATERIAL AND METHODS: A total of 40 recently extracted human maxillary canines with their crowns removed were endodontically treated. Four groups of 10 specimens were formed. Teeth were restored with titanium, quartz fiber, glass fiber, and zirconia posts and numbered as groups 1, 2, 3, and 4, respectively. All posts were cemented with Single Bond dental adhesive system and dual-polymerizing RelyX ARC adhesive resin cement. All teeth were restored with composite cores, and metal crowns were fabricated and cemented with glass ionomer cement. Each specimen was embedded in acrylic resin and then secured in a universal load-testing machine. A compressive load was applied at a 130-degree angle to the long axis of the tooth until fracture, at a crosshead speed of 1 mm/min. One-way analysis of variance and a Tukey test were used to determine the significance of the failure loads between groups (P<.001). A non-parametric chi(2) test was conducted for evaluation of the mode of failure (P<.001). RESULTS: The mean failure loads (kg) were 66.95, 91.20, 75.90, and 78.91 for groups 1 to 4, respectively. Teeth restored with quartz fiber posts (group 2) exhibited significantly higher resistance to fracture (P<.001) than the other 3 groups. Teeth restored with glass fiber and zirconia posts (groups 3 and 4) were statistically similar (P>.05). Fractures that would allow repair of the tooth were observed in groups 2 and 3, whereas unrestorable, catastrophic fractures were observed in groups 1 and 4 (P<.001). CONCLUSION: Within the limitations of this study, significantly higher failure loads were recorded for root canal treated teeth restored with quartz fiber posts. Fractures that would allow repeated repair were observed in teeth restored with quartz fiber and glass fiber posts.     

不同桩核和箍结构与牙根抗力的实验研究

目的研究不同材料桩核及箍结构对牙体抗折强度的影响。方法32颗完整离体下颌第一前磨牙于颊侧釉牙骨质界上1mm处截冠,制备残根模型;按桩核材料及箍结构不同分为四组:铸造桩核无箍结构组(A1组)、铸造桩核有箍结构组(A2组)、纤维桩无箍结构组(B1组)、纤维桩有箍结构组(B2组)。所有试件自铸造全冠颈缘完成线下2mm包埋于自凝塑料内,电子万能试验机以与牙长轴成150°、横梁位移速度1.0mm/min于颊尖顶加载,测定断裂载荷并进行统计学分析(а=0.05)。结果四组试件的折裂载荷均值(KN)依次为:1.46±0.45、1.07±0.21、1.13±0.30、1.02±0.27。铸造桩核无箍结构组表现出显著高的折裂载荷(P<0.05)。桩核材料对试件的破损模式亦有显著的影响(P<0.05)。结论残根桩核修复时,采用牙冠延长术设计2mm高的箍结构,降低了修复后牙体的抗力;使用预成纤维桩联合复合树脂核修复有利于保护残根。     

两种桩系统修复对根管治疗牙强度影响的有限元应力分析

目的比较两种不同弹性模量的桩修复对根管治疗牙应力分布的影响。方法建立根管治疗后的上颌中切牙分别采用玻璃纤维桩树脂核及铸造镍铬桩核修复的二维有限元模型，牙体预备均保留1．5mm的牙本质肩领。分析受力后的应力分布规律。结果不同材料的桩修复会在根管治疗牙牙根内产生明显不同的应力分布形式。玻璃纤维修复时牙根内的应力分布与天然牙近似，并且整体应力水平较低。铸造镍铬合金桩修复改变了天．然牙原有的应力分布形式，在桩一牙本质界面和桩末端出现了明显的应力集中。结论在选择桩的材料时要考虑其对根管治疗牙应力分布的影响。在保证牙颈部的强度和边缘密合性的同时，选择与牙本质弹性模量相近的桩可以减少根折的可能。     

不同桩核系统修复对根管治疗牙的影响

目的 比较非金属桩核系统和金属铸造桩核修复后牙体的抗折强度及牙折形式。方法 对24颗离体上颌尖牙行根管治疗并从唇侧釉牙骨质界冠方2．0mm处截冠后随机分为四组，分别用u．m.Aestheti-plus纤维桩系统、C-Post纤维桩系统、Cosmopost瓷桩系统、Ni-Cr合金铸造桩核进行桩核及铸造金属全冠恢复外形，自凝塑料包埋后，固定于生物力学试验机上测试实验牙的抗折强度并观察其折裂类型，应用SPSS分析软件进行统计学分析。结果 Cosmopost瓷桩系统修复后牙体抗折强度与Ni-Cr合金铸造桩核系统无差别，但明显高于u．m．Aestheti-plus纤维桩系统和C-Post纤维桩系统，后两者之间无统计学差异；Fisher’s精确概率法结果显示：三种非金属桩核组牙体的折裂形式与Ni-Cr合金铸造桩核组存在统计学差异。结论 在保留2．0mm牙本质领的情况下，三种非金属桩核系统修复根管治疗牙的抗折强度，均能满足临床要求；三种非金属桩核系统均有利于牙根的保护。     

Fatigue resistance of endodontically treated teeth restored with three dowel-and-core systems

STATEMENT OF PROBLEM: The successful restoration of endodontically treated teeth is enhanced by a crown design employing the ferrule effect. However, it is unclear which dowel-and-core system most effectively supports successful treatment. PURPOSE: The purpose of this study was to compare the load fatigue resistance of 3 dowel-and-core systems. MATERIAL AND METHODS: Fifteen endodontically treated maxillary central incisors were sectioned perpendicular to the long axis at a point 1.5 mm incisal to the cemento-enamel junction (CEJ). At the level of the CEJ, specimens were then prepared for crowns with 1-mm complete shoulder finish lines and 1.5 mm of axial wall height. The prepared teeth were divided into 3 groups (n=5) and restored with 1 of the following dowel-and-core combinations: Group CG, cast gold dowels and cores; Group TA, titanium alloy dowels (ParaPost XH) with composite cores; or Group FR, fiber-reinforced resin dowels (ParaPost FiberWhite) with composite cores. A dentin bonding agent (OptiBond Solo) was placed prior to the composite cores. Dowel-and-core castings and titanium alloy dowels were cemented with zinc phosphate cement. The fiber-reinforced dowels were cemented with a resin cement (ParaPost Cement). The crowns for all specimens were cast with an incisal notch for applying the fatigue load. The independent variable measured was the number of load fatigue cycles required to cause luting cement failure. The data were subjected to 1-way analysis of variance and the Student-Newman-Keuls test for 3 subsets (alpha=.05). RESULTS: The mean value+/-standard deviation for the cycles to failure for each group was: Group CG: 11,897+/-4080 load cycles, Group TA: 24,384+/-8231 load cycles, and Group FR: 50,696+/-7063 load cycles. Significant differences were found between all groups ( P<.05). CONCLUSIONS: Fiber-reinforced resin dowels and bonded composite cores under fatigue loading provided significantly stronger crown retention than cast gold dowels and cores and titanium alloy dowels with composite cores under fatigue loading.     

Survival rate and fracture strength of endodontically treated maxillary incisors with moderate defects restored with different post-and-core systems: an in vitro study

PURPOSE: This study compares the survival rate and fracture strength of endodontically treated maxillary incisors with moderate coronal defects restored with different post-and-core systems after exposure to an artificial mouth. MATERIALS AND METHODS: Sixty-four caries-free human maxillary central incisors were selected for standardized size and quality, endodontically treated, and decoronated 2 mm coronal to the cementoenamel junction. Group 1 was restored with titanium posts and composite cores, group 2 received zirconia posts and a composite core, and in group 3 zirconia posts with a heat-pressed ceramic core were used. Teeth restored with cast posts and cores served as controls. All teeth were prepared and restored with complete cast crowns. All samples were exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device. RESULTS: The survival rates of the different groups were: 94% for titanium/composite, 63% for zirconia/composite, 100% for the all-ceramic post and core, and 94% for the cast post and core. The following mean fracture strengths were obtained: titanium/composite = 425 +/- 155 N, zirconia/composite = 202 +/- 212 N, zirconia/ceramic = 378 +/- 64 N, cast post and core = 426 +/- 178 N. The lower fracture load in the group with zirconia posts and composite cores was statistically significant. The use of zirconia posts resulted in fewer oblique root fractures. CONCLUSION: Prefabricated titanium posts with composite cores, zirconia posts with heat-pressed ceramic cores, and cast posts and cores yield comparable survival rates and fracture strengths for the restoration of crowned maxillary incisors with moderate coronal defects. Survival rates and fracture strengths for zirconia posts with composite cores are significantly lower, so this combination cannot be recommended for clinical use.     

桩核修复方法对梭形根管牙断裂强度的影响

目的：比较3种不同桩核修复方法对梭形根管牙断裂强度的影响。方法：30颗近期拔除的上颌中切牙根管治疗后预备成梭形,随机分为3组,每组10颗。Ⅰ组行玻璃纤维桩、Luxacore树脂核和铸造全冠修复;Ⅱ组根管扩大预备后行铸造镍铬桩核和铸造全冠修复;Ⅲ组玻璃离子水门汀重塑根管后行铸造镍铬桩核和铸造全冠修复。Zwick z010型电子万能试验机测试断裂强度。结果：Ⅰ组与Ⅱ组、Ⅲ组试件牙的断裂强度差异有显著性,Ⅱ组与Ⅲ组差异无显著性。结论：梭形根管牙的断裂强度与其修复设计有关,采用玻璃纤维桩及树脂核修复有较高的断裂强度,且断裂方式利于再修复。     

Fracture resistance of endodontically treated teeth restored with bonded amalgam and full crowns

The use of dentin bonding prior to placement of core build-up restorations has been shown to reduce microleakage and reinforce remaining tooth structure. However, information is lacking about the influence a core build-up has on the fracture resistance of crowned teeth. The purpose of this in-vitro study was to compare the influence of three types of core build-ups on the fracture resistance of crowned teeth.     

Microleakage of endodontically treated teeth with different dowel systems

STATEMENT OF PROBLEM: Several new esthetic dowel systems are available for the restoration of endodontically treated teeth, but little is known about how effectively these dowels seal the restored teeth. PURPOSE: The purpose of this in vitro study was to compare microleakage of 3 esthetic, adhesively luted dowel systems with a conventional dowel system. MATERIAL AND METHODS: The root canals of 41 human intact single-rooted extracted teeth were prepared using a step-back technique. The teeth were randomly divided into 4 experimental groups (n=10), and 1 tooth served as a positive control. The decoronated roots were obturated with gutta-percha using lateral condensation. Roots were restored with 1 of the following dowel systems according to the manufacturer's instructions: (1) stainless steel dowels (ParaPost), (2) glass fiber dowels (Snowpost), (3) resin-supported polyethylene fiber (Ribbond) dowels, or (4) zirconia dowels (Cosmopost). Using a fluid filtration method, coronal leakage of the specimens along the dowel space and root canal restorative material was measured. Fluid movement measurements were made at 2-minute intervals for 8 minutes to measure the presence of voids existing in the obturated canals, at 1 week, 3 months, and 6 months following dowel insertion. A repeated-measures analysis of variance (ANOVA) was used to analyze logarithmic transformations of data (time and dowel material) for significant differences. The Tukey HSD test and paired 2-tailed tests were used to perform multiple comparisons (alpha=.05). RESULTS: The data indicated that the leakage values varied according to the dowel system used (P<.01). There was significant interaction between dowel systems and time of testing (P<.01). The sealing ability of zirconia dowels decreased over time (P<.01), but sealing abilities of stainless steel and resin-supported polyethylene fiber dowels remained constant (P>.05). The sealing ability of glass fiber dowels increased at 3 months (P=.032) and remained constant over the next 3 months (P=.758). Statistically, resin-supported polyethylene fiber and glass fiber dowels showed the lowest coronal leakage when compared with stainless steel and zirconia dowels at all time periods (P<.01). There were no significant differences between resin-supported polyethylene fiber and glass fiber dowels at any time period. The initial leakage measurement in zirconia dowel and stainless steel dowels were similar (P=.914), but became significantly different at 3 and 6 months (P<.01). CONCLUSION: Resin-supported polyethylene fiber dowels and glass fiber dowels tested exhibited less microleakage compared to zirconia dowel systems. The latter system should be further evaluated because of its unacceptable level of leakage.     

Fracture resistance and fracture resistance after fatigue loading of 4 different post and cores in endodontically treated teeth

This article discusses the fracture resistance of 4 post and core systems including a combined obturator/post system before and after fatigue loading. The obturator/post demonstrated the highest fracture resistance values. The use of a combined obturator/post with a single resin endodontic sealer/luting cement seems promising.