See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/255715718

Fracture resistance of endodontically treated

teeth restored with glass fiber reinforced posts
and cast gold post and cores cemented with
three cements
ARTICLE in THE JOURNAL OF PROSTHETIC DENTISTRY AUGUST 2013
Impact Factor: 1.75 DOI: 10.1016/S0022-3913(13)60352-2 Source: PubMed

CITATIONS

READS

39

7 AUTHORS, INCLUDING:
Jose-Luis Gutierrez-Perez

Daniel Torres-Lagares

Universidad de Sevilla

Universidad de Sevilla

137 PUBLICATIONS 1,009 CITATIONS

125 PUBLICATIONS 697 CITATIONS

SEE PROFILE

SEE PROFILE

Available from: Daniel Torres-Lagares

Retrieved on: 30 March 2016

Fracture resistance of endodontically

treated teeth restored with glass fiber
reinforced posts and cast gold post and
cores cemented with three cements
Carlos Torres-Snchez, DDS, MS,a Vanessa Montoya-Salazar,
DDS, MS,b Paola Crdoba, DDS, MS,c Claudia Vlez, DDS, MS,d
Andrs Guzmn-Duran, DDS, MS,e Jos-Luis Gutierrez-Prez,
DMD, PhD,f and Daniel Torres-Lagares, DDS, PhD g
School of Dentistry, University of Seville, Seville, Spain; School of
Dentistry, University Schools of Colombia, Bogot, Colombia
Statement of problem. Dental fractures can occur in endodontically treated teeth restored with glass fiber reinforced
posts and cast gold posts.
Purpose. The objective of this study was to record the fracture strength of endodontically treated teeth restored with
glass fiber reinforced or cast gold post and cores cemented with 3 cements.
Material and methods. Forty-two single-rooted premolars with standardized weakened roots were endodontically
treated and allocated to 6 experimental groups (n=7) defined by the 2 factors investigated: post system and cement.
Three groups were restored with glass fiber posts and resin-modified glass ionomer cement, dual-polymerizing resin
cement, or chemically active autopolymerizing resin cement. The other 3 groups were restored with cast gold post and
cores and the same 3 cements. The cores of the glass fiber post groups were fabricated with composite resin core material. Metal crowns were cemented on the cores in the 6 groups. The entire system was subjected to continuous compression in a universal testing machine, and fracture limit and location (cervical third, middle third, or apical third)
were noted. Two-way ANOVA and the Scheff test were used to analyze the data and compare the groups (=.05).
Results. Two-way ANOVA showed significant differences in the post type (P<.001) and the cements (P<.001). The
interaction between them (P<.001) was statistically significant in the fracture resistance of the endodontically treated
teeth. The greatest interaction between post and cement was the glass fiber post with resin-modified glass ionomer
cement, followed by the cast gold post and core with resin-modified glass ionomer cement.
Conclusions. The use of a glass fiber reinforced post and resin-modified glass ionomer cement increased the fracture
resistance of endodontically treated teeth. (J Prosthet Dent 2013;110:127-133)

Clinical Implications
In situations involving weakened roots, a glass fiber post luted with resinmodified glass ionomer cement represents a viable alternative for the prosthetic restoration of endodontically treated teeth. Post systems with an
elastic modulus similar to that of dentin and core have a biomechanical
advantage because fractures occur more frequently at the cervical third of
the tooth, resulting in a better prognosis. In addition, glass fiber posts can
be removed and replaced easily without the risk of perforating the root.
a

PhD student, Department of Stomatology, Faculty of Dentistry, University of Seville.

PhD student, Department of Stomatology, Faculty of Dentistry, University of Seville.
c
Private practice, Bogota, Colombia.
d
Private practice, Bogota, Colombia.
e
Professor and Chief, Department of Prosthodontics, Faculty of Dentistry, University schools of Colombia.
f
Master Chief of Oral Surgery, Faculty of Dentistry, University of Seville.
g
Master Chief of Oral Surgery, Faculty of Dentistry, University of Seville.
b

Torres-Snchez et al

128

Volume 110 Issue 2

Studies have documented the
physical properties of metal posts
used to restore endodontically treated teeth,1-3 and several have demonstrated that cast post and cores
adapted to the root walls weaken the
tooth root instead of reinforcing it.4-6
Root weakness during endodontic
therapy is the second leading cause
of failure in endodontically treated
teeth.6,7 In order to minimize root
weakness, fiber posts and carbon fiber reinforced posts have been used.
These materials have a modulus of
elasticity similar to root dentin and
avoid a concentration of force on the
post-dentin interface.8,9 In addition,
glass fiber posts can be removed and
replaced easily without the risk of perforating the root.10
Tooth structure removal directly
influences strain values and fracture
resistance within the remaining tooth
structure of endodontically treated
teeth. Teeth restored with direct composite resin veneers without posts
show more root fractures than the
teeth restored with the same technique but with glass fiber posts.11
The most important factor in the
fracture resistance of endodontically
treated teeth is the amount of coronal tissue remaining after preparation.
Numerous in vitro and clinical studies
have shown that leaving 2 mm of clinical coronal tissue around the entire circumference of the tooth creates resistance such that the material and design
of the post is no longer relevant.5-7,12-17
This remaining healthy coronal tissue
forms the ferrule. However, it has also
been shown that endodontically treated teeth that have undergone clinical
crown lengthening to create a ferrule
are significantly less resistant to fracture than teeth without a ferrule.18.
Also, it has been demonstrated that
posts do not reinforce endodontically
treated teeth structure.19
Several in vitro studies of endodontically treated teeth have demonstrated biomechanical advantage
in absorbing forces and fracture resistance by applying the load on a cast
crown and not directly on the glass

fiber tooth abutment. A metal crown

with a 2-mm ferrule more closely represents the clinical situation.20-25 Recent studies have shown that glass
fiber posts can be an adequate alternative to casts posts.26
This study recorded the force to
fracture to identify differences between luting cements and the types of
posts used for endodontically treated
teeth. Secondary study objectives focused on confirming 2 conclusions
outlined in other studies: with 2 mm
of remaining tooth structure, no difference in fracture values between
various groups according to design
and material used should be observed; and cast posts cause greater
weakness than glass fiber posts.
The null hypothesis was that no
significant difference in fracture resistance exists between teeth restored
with glass fiber reinforced posts and
Type IV gold cast post and cores cemented with resin-modified glass
ionomer cement, dual-polymerizing
resin cement, and chemically active
autopolymerizing resin cement.

MATERIAL AND METHODS

A pilot study was performed to assess the reproducibility of the method
and to calculate the sample size of 2
per group. The statistical sampling test
used was determined by the following
formula with a method error of 95%
confidence.

The authors selected 42 singlerooted premolars with the following

inclusion criteria. They were healthy
teeth recently extracted (within 6
weeks of extraction)27 for orthodontic reasons, with a root length between 14 and 16 mm, 1 root canal,
no incipient occlusal and/or proximal
caries, and minimal or absent occlusal restorations. Premolars that were
dehydrated or fractured or had accessory root canals, significant caries, or
restorations were excluded. The specimens were randomly assigned to 6 ex-

The Journal of Prosthetic Dentistry

perimental groups by using a computer-generated list (n=7), defined by the

2 factors investigated: post system
and cement (Table I).
Experimental Procedure
The teeth were subjected to radiographic examination and were stored
in 0.5% Chloramine T (Delchimica;
Scientific Glassware, Naples, Italy) at
4C and were used within 6 weeks of
extraction.27 The roots were coated
with a 0.4-mm layer of baseplate wax
(Base Plate Wax; Kerr, Orange, Calif )
and by using a surveyor (Ney surveyor lock nut style 9995417; Dentsply
Maillefer, Ballaigues, Switzerland)
were mounted perpendicular to the
base of 3 3 cm polystyrene resin
(AM 190 resin; AeroJet, Santo Amaro,
Brazil) cubes. The level of the epoxy
resin reached 2 mm from the cementenamel junction to simulate the natural bone level. The wax was removed
with hot water, and the space left behind between the tooth and the acrylic resin was replaced with elastomer
impression material (Permlastic; Kerr
Corp, Orange, Calif ), simulating the
periodontal ligament.
Endodontic access was performed
with a round diamond rotary cutting
instrument (18163 Great white Z; SS
White, Lakewood, NJ) and the root
canal permeability was confirmed
with a number 10 K-file (K-file; Dentsply Maillefer). The length of the root
canal was determined and biomechanical preparation was performed
with hand files (Protaper Universal
System; Dentsply Maillefer) and rotary instrumentation (Dentaport ZX;
J. Morita Corp, Osaka, Japan) up to
the F3 file 1 mm from the apex. Sodium hypochlorite irrigation (Chlorcid
V; Ultradent Products, South Jordan,
Utah) and lubrication (Ultradent
EDTA; Ultradent Products) was used.
The root canal was dried with paper
points and sealed with cement (Sealapex; Kerr Corp) and gutta percha
points (Protaper gutta percha points;
Dentsply Maillefer).
The tooth was prepared leaving 2

Torres-Snchez et al

129

August 2013

Table I. Study groups

Post System

Cement

FP
Glass Fiber
Reinforced Post

GP
Gold Cast
Post And Core

FP-RMGI

GP-RMGI

FP-DPRC

GP-DPRC

FP-APRC

GP-APRC

RMGI
Resin-modified glass
ionomer cement
DPRC
Dual-polymerizing
resin cement
APRC
Chemically active
autopolymerizing resin cement
(n=7) for each group.

1 A, Root weakening machine. B, Weakened root. C, Resistance test. D, Specimen after test.
mm of coronal tissue around the cement-enamel junction by using a highspeed cylindrical bur (18161 Great
white Z; SS White) with a rounded
end. The entrance of the root canal was widened, leaving a 1.25-mm

Torres-Snchez et al

thick wall to a depth of 4 mm. The

rest of the root canal was unsealed
to a depth of 10 mm with Peeso burs
(Peeso Burs; Dentsply Maillefer) of
various diameters (1.14 mm, 1.25
mm, 1.40 mm, and 1.50 mm) with

a root-weakening machine designed

and fabricated for this study (Fig. 1A,
B). This device provided a manually
controlled downward movement by
means of a lever pushing directly on a
rack and pinion shaft. Upward move-

130

Volume 110 Issue 2

ment was controlled by means of a helical pressure spring acting as a travel
stop for the drill holder. The handpiece
was set by means of screwed-on plates
whose angle of inclination allowed for
vertical movement of the handpiece.
The specimen to be drilled was placed
in the cube-shaped specimen holder,
which provided micrometer displacements on the x and y axes. The entire
unit was anchored on a flat metal base.
Restoration fabrication
The groups were classified and
defined by the 2 factors investigated,
post system and cement, as follows:
FP-RMGI, glass fiber post cemented
with resin-modified glass ionomer cement; FP-DPRC, glass fiber post cemented with dual-polymerizing resin
cement; FP-APRC, glass fiber post
cemented with chemically active autopolymerizing resin cement; GP-RMGI, cast gold post and core cemented
with resin-modified glass ionomer cement; GP-DPRC, cast gold post and
core cemented with dual-polymerizing resin cement; GP-APRC, cast gold
post and core cemented with chemically active autopolymerizing resin cement. (Table I).
After root weakening, the thickness of the intraroot posts was confirmed by radiographic evaluation.
Acrylic resin (Duralay; Reliance Dental Mfg Co, Worth, Ill) was used to
fabricate the cast post and core patterns. The acrylic resin patterns were
cast in Type IV gold alloy (Argendent
90; The Argen Corp, San Diego, Calif ) GP. The cements: Resin-modified
glass ionomer cement (RelyX Luting;
3M ESPE, St Paul, Minn) RMGI, dual-polymerizing resin cement (RelyX
ARC; 3M ESPE)
DPRC, and chemically active autopolymerizing resin cement (Multilink System Pack; Ivoclar Vivadent,
Schaan, Liechtenstein) APRC, were
mixed according to the manufacturers instructions. Cement was applied to each post, and the post was
seated in the post space with finger
pressure. Excess cement was removed

flush with the top of the tooth. The

posts remained passive in the canals
while the cement polymerized.27 For
the glass fiber posts (Tenax; Coltne/
Whaledent, Altsttten, Switzerland)
FP, the cores were fabricated directly with composite resin (Paracore;
Coltne/Whaledent). Finally, a basemetal alloy crown (Argeloy N.P; The
Argen Corporation) was cemented
onto the cores with type I glass ionomer (GC Fuji Plus; GC America; Alsip,
Ill). The crown had been previously
waxed, adapted, and polished directly on the tooth preparations (light
chamfer). The crowns incorporated
a 2 2 mm ledge in the buccal cusp
for reproducible placement of the tip
of the mechanical testing machine
(Satec 600DX; Instron Corp, Barcelona, Spain). A special base was designed to place the cube of each specimen at 60 degrees to the mechanical
testing machine (Satec 600DX; Instron
Corp) (Fig. 1C, D). A continuous compressive force at a constant speed of 3
mm/min was applied until fracture occurred (Fig. 1D).
The dependent variables assessed
in this study were fracture resistance
and site of fracture. The independent
study variables were the cement and
post type. These data were collected
in a software application (Microsoft
Excel; Microsoft, Redmond, Wash)
and exported for statistical analysis
(SPSS v11; IBM, Armonk, NY). The
means of the groups were compared
by using 2-way ANOVA and the Scheff test (=.05). Data relating to the
location of the fracture were evaluated only descriptively.

RESULTS
The small sample size allowed only
a descriptive analysis of the frequency
of fracture zones. Analysis of the fractures showed that the most frequent
fracture site for the cast intraroot
posts was the middle third, 10 teeth
of 21 (47.10%), followed by the cervical third, 7 teeth of 21 (33.3%) (Table
II). In teeth restored with prefabricated posts, the most frequent fracture

The Journal of Prosthetic Dentistry

site was the cervical third, 9 teeth of

21 (42.9%). In terms of the cementing agent, fractures where DPRC was
used were most frequently located in
the middle third, 6 teeth of 14 (42.9%)
(Table III). For teeth where RMGI
was used, the sector most affected
by fractures was the cervical third,
9 teeth of 14 (64.3%). As for APRC,
fractures affecting the middle third
and apical third were the most frequent, 5 fractures in each group of 14
teeth (35.7%). Analysis of the fracture
sites for the various groups is shown
in Table IV. Sixteen fractures occurred
in the cervical third with the following distribution according to groups:
the FP-RMGI 5 fractures (31.25%),
FP-APRC and GP-RMGI 4 fractures
in each group (25%) and GP-DPRC 3
fractures (18.75%). Sixteen fractures
occurred in the middle third with
the following distribution according
to groups: FP-RMGI, FP-DPRC, and
FP-APRC 2 fractures in each group
(12.5%), GP-RMGI and GP-APRC 3
fractures in each group (18.75%), GPDPRC 4 fractures (25%). Ten fractures
occurred in the apical third with the
following distribution according to
groups: FP-DPRC 5 fractures (50%),
FP-APRC 1 fracture (10%), and GPAPRC 4 fractures (40%).
The 2-way ANOVA showed significant differences in post type (P<.001),
cement (P<.001), and the interaction
between them (P<.001) (Table V). The
mean values of fracture resistance of
the different study groups are shown in
Figure 2. The interaction between post
and cement that showed greater resistance to fracture was FP-RMGI (127.91
N 14.02), followed by the group GPRMGI (79.92 N 5.66).
The Scheff test identified significant differences among the groups
(Fig. 2). The FP-RMGI group (127.91
N 14.02) (P<.05), the GP-RMGI
group (79.92 N 5.66) (P<.05), and
the GP-APRC group (55.40 N 5.88)
(P<.05) showed the greatest fracture
resistance, and they were significantly
different to the other groups. No significant difference among FP-DPRC
(48.21 N 4.61), GP-DPRC (38.04 N

Torres-Snchez et al

131

August 2013

Table II. Location of fracture (by post)

Table III. Location of fracture (by cement)

Post
Third

FP

Cervical
Middle

Cement
GP

Total

Third

RMGI

DPRC

APRC

Total

9 (42.9%)

7 (33.3%)

16 (38.1%)

Cervical

9 (64.3%)

3 (21.4%)

4 (28.6%)

16 (38.1%)

6 (28.6%)

10 (47.6%)

16 (38.1%)

Middle

5 (35.7%)

6 (42.9%)

5 (35.7%)

16 (38.1%)

Apical

6 (28.6%)

4 (19.0%)

10 (23.8%)

Apical

0 (0%)

5 (35.7%)

5 (35.7%)

10 (23.8%)

Total

21 (100%)

21 (100%)

42 (100%)

Total

14 (100%) 14 (100%)

14 (100%)

42 (100%)

Table IV. Location of fracture (by cement and post)

Cervical Third Middle Third Apical Third
% (n)
% (n)
% (n)

Group

(FP-RMGI)

31.25 (5)

12.5 (2)

0 (0)

(FP-DPRC)

0 (0)

12.5 (2)

50 (5)

(FP-APRC)

25 (4)

12.5 (2)

10 (1)

(GP-RMGI)

25 (4)

18.75 (3)

0 (0)

(GP-DPRC)

18.75 (3)

25( 4)

0 (0)

(GP-APRC)

0 (0)

18.75 (3)

40 (4)

Total

42

100 (16)

100 (16)

100 (10)

Table V. Two-way ANOVA (32) for fracture resistance

Source of
Variation

df

Sum of
Squares

Mean
Square

Post

2073

2073

40

<.001

Cement

32234

16117

308

<.001

Post Cement

72461

3624

70

<.001

Error

36

1884

Total

42

219877

Corrected Total

41

43438

Differences are significant at P<.05

140
120

(N)

100
80
60
40
20
0

RMGI/FP

DRPC/FP

APRC/FP

RMGI/GP

DRPC/GP

APRC/GP

2 Mean fracture resistance values in each group study. Differences among

study groups; statistical categories defined by Scheff test. Significance P<.05

Torres-Snchez et al

132

Volume 110 Issue 2

3.89), and FP-APRC (39.04 N 3.78)
was noted. RMGI cement was the better by itself but worked much better
with the FP (P<.05). DPRC worked
best with the FP than with the GP but
the difference was not significant, and
APRC worked better than DPRC with
the GP. Furthermore, GP-APRC was
significantly better than FP-DPRC, GPDPRC, and FP-APRC (P<.05).

DISCUSSION
The small sample size allowed only
a descriptive analysis of the frequency of fracture zones. A larger sample
size would be needed to statistically
analyze the location of the fracture.
Based on the 2-way ANOVA results,
the null hypothesis was rejected. Significant differences in fracture resistance were recorded among teeth restored with RMGI, DPRC, and APRC
used to cement fiber reinforced posts
and gold cast posts. The goal of the
investigation was to find the material
combination most likely to resist fractures in root-weakened teeth. One of
the limiting factors of this study was
that teeth in their natural environment respond differently to physiologic loads because of the presence
of resilient periodontal ligaments and
bone. Therefore, a biomechanical advantage in absorbing forces was provided by applying the load on a cast
crown, and not directly on the core
of the retainer, as other studies have
done.20,21
The placement of an endodontic
post creates an unnaturally restored
structure, since the root canal space
is filled with a material that is unlike
pulp with regard to stiffness. Stress is
more uniform in a sound tooth.28,29
However, the physiological differences between cement, posts, and
enamel cause the produced stress to
concentrate in the cervical region,
as a nonhomogeneous distribution
material causes the stress concentration.29 Consequently, the interface of
materials with a different elastic module represent the weakest point of a
restorative system.9,30,31

The preparation of a metal crown

was included in the study as a constant. For the preparation of the
crowns, various parameters such as
the minimum retention and resistance needed for receiving this restoration were considered.20,21 Results
indicated better mechanical behavior of teeth restored with glass fiber
posts cemented with resin-modified
glass ionomer cement than with dualpolymerizing and autopolymerizing
resin cements, although a minimum
of 2 mm of remaining tooth structure
was maintained for all teeth. Greater
forces were necessary to cause fracture of the resin-modified glass ionomer cement group, thereby highlighting the role played by the cementing
agent in resisting tangential forces.19
The results of this study agree with
others that found glass fiber posts
cemented with resin-modified glass
ionomer cement can be an adequate
alternative to cast posts.26 Although
the fracture resistance of restorations
with prefabricated glass fiber posts
is similar to those with stainless steel
metal posts,22 this study has shown
improved performance of fiber reinforced post, because of the greater
modulus of elasticity of metal posts.
This study confirmed that if sufficient
tooth crown structure remains, the
material in which the intraroot retention is made does not have a significant impact on the force to fracture, although better behavior was
observed with FP. This disagrees with
the results of a recent clinical study
that found no significant differences
between cast and glass fiber posts.23
Regarding the cementing agent,
both FP and GP cemented with RMGI
showed better fracture resistance than
FP cemented with DPRC and APRC.
This may be due to chemical bonding between tooth tissue and RMGI,
which could generate additional reinforcement against continuous forces.
The second best resin cement was the
APRC, a finding consistent with the
study conducted by Attar et al,24 who
reported that APRC had a greater flexural resistance than DPRC. According

The Journal of Prosthetic Dentistry

to the authors, the light of the polymerizing unit might not completely
reach these cements, and, therefore,
they did not completely polymerize.
This caused greater conversion of radicals in the APRC than in the DPRC.24
The fracture resistance of endodontically treated premolars was
dependent on the number of residual
coronal dentin walls. The placement
of a glass fiber post significantly influenced the fracture resistance when
fewer than 2 cavity walls remained.
Based on the results of this study, it
is recommended that endodontically
treated premolars with fewer than 2
remaining cavity walls be restored
with posts before restoration with
crowns.11 According to other studies with glass fiber posts and the 2
mm ferrule effect, the fractures encountered were less severe and occurred more frequently in the cervical
third.13,25 In the present study, this
was also the case, confirming previous findings. Glass fiber posts can
be removed and replaced easily without the risk of perforating the root.10
Similar to the findings by Akkayan,13
more severe failures were found in GP,
possibly because the cast post has a
greater modulus of elasticity than
root dentin.
Recent studies, including this
study, show that glass fiber posts
increase fracture resistance in endodontically treated teeth.26 The present study did not show significant
differences in fracture resistance between post types, but the advantage
of glass fiber posts is that they can
be removed and replaced easily without the risk of perforating the root10:
most root fractures were in the third
cervical and, therefore, easily restorable. Further studies using cyclic loading and thermocycling may provide
greater similarity to the forces exerted
in the oral cavity.

CONCLUSIONS
Within the limitations of this study,
the following conclusions were drawn:
1. The use of glass fiber reinforced

Torres-Snchez et al

133

August 2013
posts increased the fracture resistance of endodontically treated teeth
(P<.001), and the use of resin-modified glass ionomer cement increased
the resistance to fracture (P<.001).
2. In the interaction between posts
and cements, the highest fracture resistance was found in the glass fiber
reinforced post cemented with resin
modified glass ionomer cement group
(P<.001).

REFERENCES
1. Sorensen JA, Martinoff JT. Intracoronal reinforcement and coronal coverage: a study
of endodontically treated teeth. J Prosthet
Dent 1984;51:780-4.
2. Eckerbom M, Magnusson T. Restoring
endodontically treated teeth: A survey of
current opinions among board-certified
prosthodontists and general dental
practitioners in Sweden. Int J Prosthodont
2001;14:245-9.
3. Grandini S, Goracci C, Tay FR, Grandini R,
Ferrari M. Clinical evaluation of the use of
fiber posts and direct resin restorations for
endodontically treated teeth. Int J Prosthodont 2005;18:399-404.
4. Piovesan EM, Demarco FF, Cenci MS,
Pereira-Cenci T. Survival rates of endodontically treated teeth restored with fiber-reinforced custom posts and cores: a 97-month
study. Int J Prosthodont 2007;20:633-9.
5. Leary JM, Aquilino SA, Svare CW. An evaluation of post length within the elastic limits
of dentin. J Prosthet Dent 1987;57:277-81.
6. Trope M, Maltz DO, Tronstad L. Resistance to fracture of restored endodontically treated teeth. Endod Dent Traumatol
1985;1:108-11.
7. Musikant BL, Deutsch AS. Endodontic
techniques defined by principles. NY State
Dent J 2004;70:18-21.
8. Barjau EA, Sancho JL, Forner NL, Rodrguez
CP, Prez GA, Snchez MF. Influence of prefabricated post material on restored teeth:
Fracture strength and stress distribution.
Oper Dent 2006;31:47-54.
9. Spazzin AO, Galafassi D, Meira-Jnior AD,
Garbin CA. Influence of post and resin
cement on stress distribution of maxillary
central incisor restored with direct resin
composite. Oper Dent 2009;34:223-9.

Torres-Snchez et al

10.Mannocci F, Ferrari M, Watson TF. Intermittent loading of teeth restored using

quartz fiber, carbon-quartz fiber, and
zirconium dioxide ceramic root canal posts.
J Adhes Den 1999;1:153-8.
11.Miranda VA, Arajo RL, Simamoto JP,
Rezende NV, Soares CJ. The effect of fiber
post presence and restorative technique on
the biomechanical behavior of endodontically treated maxillary incisors: An in vitro
study. J Prosthet Dent 2012;108:147-57.
12.Newman MP, Yaman P, Dennison J, Rafter
M, Billy E. Fracture resistance of endodontically treated teeth restored with composite posts. J Prosthet Dent 2003;89:360-7.
13.Akkayan B. An in vitro study evaluating
the effect of ferrule length on fracture
resistance of endodontically treated
teeth restored with fiber-reinforced and
zirconia dowel systems. J Prosthet Dent
2004;92:155-62.
14.Ma PS, Nicholls JI, Junge T, Phillips KM.
Load fatigue of teeth with different ferrule
lengths, restored with fiber post, composite resin cores, and all-ceramic crowns. J
Prosthet Dent 2009;102:229-34.
15.Milot P, Stein RS. Root fracture in endodontically treated teeth related to post
selection and crown design. J Prosthet Dent
1992;68:428-35
16.Sorenssen JA. Preservation of tooth structure. J Calif Dent Assoc 1988;16:15-22.
17.Sorenssen JA. Engelman MJ. Ferrule design
and fracture resistance of endodontically
treated teeth. J Prosthet Dent 1990;63:529-36.
18.Gegauff AG. Effect of crown lengthening
and ferrule placement on static load failure
of cemented cast post-cores and crowns. J
Prosthet Dent 2000;84:169-79.
19.Guzy GE, Nicholls JI. In vitro comparison
of intact endodontically treated teeth with
and without endopost reinforcement. J
Prosthet Dent 1979;42:39-44.
20.Holmes DC, Diaz-Arnold AM, Leary JM.
Influence of post dimension on stress
distribution in dentin. J Prosthet Dent
1996;75:140-7.
21.Mannocci F, Ferrari M, Watson TF. Microleakage of endodontically treated teeth restored with fiber posts and composite cores
after cyclic loading: a confocal microscopic
study. J Prosthet Dent 2001;8:284-91.
22.Chuang SF, Yaman P, Herrero A, Dennison
JB, Chang CH. Influence of post material
and length on endodontically treated incisors: An in vitro and finite element study. J
Prosthet Dent 2010;104:379-88.

23.Jung RE, Kalkstein O, Sailer I, Roos M,

Hmmerle CH. A comparison of composite
post buildups and cast gold post-and-core
buildups for the restoration of nonvital
teeth after 5 to 10 years. Int J Prosthodont
2007;20:63-9.
24.Attar N, Tam LE, McComb D. Mechanical and physical properties of contemporary dental luting agents. J Prosthet Dent
2003;89:127-34.
25.Heydecke G, Butz F, Hussein A, Strub JR.
Fracture strength after dynamic loading of
endodontically treated teeth restored with
different post-and-core-systems. J Prosthet
Dent 2002;87:438-45.
26.Giovani AR, Vasan LP, de Sousa Neto MD,
Paulino SM. In vitro fracture resistance of
glass-fiber and cast metal post with different
lengths. J Prosthet Dent 2009;101:183-8.
27.Aleisa K, Alghabban R, Alwazzan K, Morgano SM. Effect of three endodontic sealers
on the bond strength of prefabricated fiber
posts luted with three resin cements. J Prosthet Dent 2012;107:322-6.
28.Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated
teeth. J Prosthet Dent 1994;71:565-7.
29.Lanza A, Aversa R, Rengo S, Apicella D,
Apicella A. 3D FEA of cemented steel, glass
and carbon posts in a maxillary incisor.
Dent Mater 2005;21:709-15.
30.Zarone F, Sorrentino R, Apicella D, Valentino B, Ferrari M, Aversa R, et al. Evaluation
of the biomechanical behavior of maxillary
central incisors restored by means of endocrowns compared to a natural tooth: a 3D
static linear finite elements analysis. Dent
Mater 2006;22:1035-44.
31.Ausiello P, Gee AJ, Rengo S, Davidson
CL. Fracture resistance of endodonticallytreated premolars adhesively restored. Am J
Dent 1997;10:237-41.
Corresponding author:
Dr Daniel Torres-Lagares
University of Seville, Faculty of Dentistry
Avicena s/n. 41009-Sevilla
SPAIN
E-mail: danieltl@us.es
Copyright 2013 by the Editorial Council for
The Journal of Prosthetic Dentistry.