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1 s2.0 S0022391305005780 Main PDF
1 s2.0 S0022391305005780 Main PDF
Purpose. The purpose of this study was to compare the fracture strengths of endodontically treated teeth using
posts and cores and variable quantities of coronal dentin located apical to core foundations with corresponding
ferrule designs incorporated into cast restorations.
Material and methods. Fifty freshly extracted canines were endodontically treated. The teeth were randomly
divided into groups of 10 and prepared according to 5 experimental protocols. Control group: teeth with custom cast post and core; 0-mm group: teeth without coronal structure (no ferrule); 1-mm, 2-mm, and 3-mm
groups: teeth with 1 mm, 2 mm, and 3 mm of remaining coronal tooth structure (1-, 2-, and 3-mm ferrule),
respectively. All specimens in 0-mm through 3-mm (noncontrol) groups were restored with a prefabricated post
(Screw-Post) and composite resin (Z100) core located superior to the different tooth structure heights. All teeth
were restored with complete metal crowns. The fracture resistance (N) was measured in a universal testing
machine at 45 degrees to the long axis of the tooth until failure. Data were analyzed by 1-way analysis of variance
and Tukey test (a=.05).
Results. Significant differences (P,.001) were found among the mean fracture forces of the test groups (control group: 818.2 N; 0-mm, 1-mm, 2-mm, and 3-mm groups: 561.0 N, 627.6 N, 745.3 N, and 907.1 N,
respectively). When the mode of failure was evaluated, all failures in the control group occurred due to root fracture, and all failures in the 0-mm group occurred due to core fracture. The majority of failures in the other
groups occurred due to crown cementation failure.
Conclusion. The results of this study showed that an increased amount of coronal dentin significantly increases
the fracture resistance of endodontically treated teeth. (J Prosthet Dent 2006;95:50-4.)
CLINICAL IMPLICATIONS
This in vitro study demonstrated that increasing the size of ferrule designs in crowns had a significant effect on the fracture resistance of endodontically treated teeth restored with prefabricated posts and composite resin cores.
PEREIRA ET AL
tooth/core junction was found to enhance fracture resistance.18 It appears that this extension of coronal tooth
structure provides the greatest influence in terms of resistance and retention form for a crown.19,20 Several authors8,21,22 have suggested that a tooth should have a
minimum of 2 mm of coronal structure above the cementoenamel junction (CEJ) to ensure proper resistance form for a tooth. This 2 mm of tooth structure
will provide a ferrule effect with the artificial crown
that should prevent fracture of the root, fracture of the
post, and dislodgement of the post.23-26 Gegauff 25 evaluated the effect in vitro of simulated surgical crown
lengthening and found that there was no significant difference between the amount of remaining coronal structure and fracture resistance. Thus, authors have different
opinions about the ideal amount of remaining coronal
tooth structure. The fracture resistance of endodontically treated teeth restored using cast posts or prefabricated posts as described in the literature may be
acceptable, clinically, because the reported fracture resistance is considerably higher than the maximal physiologic forces acting on the teeth in the oral cavity.27
The purpose of this study was to compare the fracture
resistance of endodontically treated teeth with varying
amounts of coronal tooth structure available for crown
preparation with the remaining tooth structure restored
with prefabricated posts and complete metal crowns.
The research hypothesis was that the amount of coronal
structure would have a significant effect on fracture
resistance and type of fracture.
PEREIRA ET AL
above the CEJ (Fig. 1). For the 2-mm and 3-mm
groups, the coronal tooth structures were reduced to a
flat plane at heights of 2.0 mm and 3.0 mm incisal to
the CEJ, respectively, and restored in the same manner
as the 1-mm group.
All specimens were prepared with a diamond rotary
cutting instrument (#3216; KG Sorensen, Barueri, Sao
Paulo, Brazil) in a high-speed handpiece with water
spray (Super Torque 625 Autofix; KaVo do Brazil Ind,
Com, Ltd, Joinville, SC, Brazil). Specimens were prepared to receive complete crowns (1.5-mm facial reduction with a chamfer finish line and 0.5-mm chamfered
lingual reduction). The finish lines for all specimens
were placed at the level of the CEJ. An impression
was made using a vinyl polysiloxane impression material (Aquasil; Dentsply DeTrey GmbH, Konstanz,
Germany) of the tooth prior to preparation and used
to fabricate the wax pattern. Wax (Kerr Corp, Orange,
Calif) was then poured into the impression; the tooth
was inserted into it. After the wax cooled, the impression
was removed and the margins were perfected. The wax
patterns were sprued, invested (Cristobalite; Whip Mix
Corp), and cast in a Ni-Cr alloy (Durabond, Sao Paulo,
Brazil). Crowns were luted to the teeth with glass-ionomer cement (Rely X; 3M ESPE).
The root surface of each tooth was coated with a layer
(approximately 60 mm) of silicone impression material
(Aquasil; Dentsply DeTrey) to simulate a periodontal
ligament.28 Root surfaces were marked 2 mm below
the CEJ and covered with a 0.6-mm-thick foil (Adapta
foil; BEGO, Bremen, Germany). All specimens were
embedded in acrylic resin (Artigos Odontologicos
Classico S/A, Sao Paulo, Brazil) poured into molds
made of the same material (30 mm high and 22 mm
in diameter, with an internal opening in the center of
the mold 20 mm high and 10 mm in diameter). The
teeth were embedded along their long axes using a surveyor (Bio-Art Equipamentos Odontologicos Ltd, Sao
Carlos, SP, Brazil) and placed in a cool water bath during the polymerization of the resin. After the first signs
of polymerization, teeth were removed from the resin
blocks along their long axes using the surveyor, and
52
PEREIRA ET AL
Groups
Effect
0 mm
1 mm
2 mm
Control
3 mm
Mean (N)
561.0a
627.6ab
745.3abc
818.2bc
907.1c
SD
136.8
122.6
144.8
147.9
269.9
df
effect
MS
effect
df
error
2040.936
45
Type of
restoration
RESULTS
Table I summarizes the mean fracture resistance for
the 5 test groups. The ANOVA (Table II) showed that
1 or more of the conditions were significantly different
from each other (P,.001). The Tukey test confirmed
that the mean fracture resistance for the control group
was significantly greater than for the 0-mm group, and
fracture resistance for the 3-mm group was significantly
greater than for the 0-mm and 1-mm groups (Table I).
When the mode of failure was evaluated, all failures in
the control group occurred due to root fracture, and
all failures in the 0-mm group occurred due to core fracture. As for the other groups, the majority of failures occurred due to crown cementation failure (Table III).
DISCUSSION
The hypotheses that there was a significant difference
in the effect of remaining coronal tooth structure on the
fracture resistance of endodontically treated teeth and a
significant difference between the types of fractures and
the type of post system used were accepted. Core fabrication using prefabricated posts and composite resin is a
viable technique for endodontically treated teeth.10-12
Fracture of the composite resin core when occlusal force
is applied may occur as protection of the supporting
root.14
This study showed that increasing ferrule length significantly increased the fracture resistance of endodontically treated teeth restored with prefabricated posts and
cores. However, it is important to note that the forces
responsible for failure in this study were considerably
higher than the maximal physiologic forces acting on
the teeth intraorally.27 Lyons and Baxendale 27 observed
that the mean force applied on a maxillary canine
was 215 N. In the presence of parafunctional loading,
the authors noted that this force increased to 254.8 N,
and the maximum forces were between 343 and
362.6 N.
It was observed that the control group presented significantly higher fracture resistance when compared
JANUARY 2006
MS
error
Location of failure
Groups
Resin
composite
only
Root only
Control
0 mm
1 mm
2 mm
3 mm
Total
10 (100%)
2 (20%)
12 (24%)
10 (100%)
10 (20%)
Crown
cementation
failure
7 (70%)
6 (60%)
13 (26%)
Coronal
structure
1
4
10
15
(10%)
(40%)
(100%)
(30%)
CONCLUSION
Within the limits of this study, the following conclusions were drawn:
1. Increasing ferrule length significantly (P,.05) increased the fracture resistance of endodontically treated
teeth restored with prefabricated posts and cores.
2. The 3-mm ferrule group showed significantly higher
fracture resistance (P,.05) when compared with the 0mm and 1-mm ferrule groups.
3. The presence of 2 mm of ferrule length significantly
increased (P,.05) the resistance of endodontically treated teeth restored with a prefabricated post and core
when compared with teeth without a ferrule.
4. The group restored with prefabricated post and composite resin core showed crown cementation failure before fracture of the root occurred. By contrast, the
specimens restored with cast post and core typically
showed fracture of the root.
REFERENCES
1. Tjan AH, Whang SB. Resistance to root fracture of post channels with various thicknesses of buccal dentin walls. J Prosthet Dent 1985;53:496-500.
2. Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated teeth. J Prosthet Dent 1994;71:565-7.
3. Cohen BL, Pagnillo M, Condos S, Deutsch AS. Comparison of torsional
forces at failure for seven endodontic post systems. J Prosthet Dent
1995;74:350-7.
4. Gutmann JL. The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth. J Prosthet Dent 1992;
67:458-67.
5. Guzy GE, Nicholls JI. In vitro comparison of intact endodontically treated
teeth with and without endo-post reinforcement. J Prosthet Dent 1979;42:
39-44.
6. Lovdahl PE, Nicholls JI. Pin retained amalgam cores vs. cast-gold dowelcores. J Prosthet Dent 1977;38:507-14.
7. Sorensen JA, Martinoff JT. Intracoronal reinforcement and coronal coverage: a study of endodontically treated teeth. J Prosthet Dent 1984;51:
780-4.
8. Sorensen JA, Engelman MJ. Ferrule design and fracture resistance of
endodontically treated teeth. J Prosthet Dent 1990;63:529-36.
54
PEREIRA ET AL
APTO
05
0022-3913/$32.00
Copyright 2006 by The Editorial Council of The Journal of Prosthetic
Dentistry.
doi:10.1016/j.prosdent.2005.10.019
VOLUME 95 NUMBER 1