Basic Research—Technology

Influence of Ferrule, Post System, and Length on Stress

Distribution of Weakened Root-filled Teeth
Paulo C
esar Freitas Santos-Filho, DDS, MS, PhD,* Crisnicaw Ver
ıssimo, DDS, MS,*
Lu
ıs Henrique Ara
ujo Raposo, DDS, MS, PhD,† Pedro Yoshito Noritomi, MecEng, MS, PhD,‡
and Luis Roberto Marcondes Martins, DDS, MS, PhD§

Abstract
Introduction: The aim of this study was to evaluate the
influence of a ferrule, post system, and length on the
stress distribution of weakened root-filled teeth.
Methods: The investigation was conducted by using
3-dimensional (3D) finite element analysis. A sound
tooth and 8 3D models of a weakened root-filled central
incisor were generated using computer-aided design/
computer-aided manufacturing software. The models
were created without a ferrule and with a 2.0-mm
ferrule, restored with a relined glass fiber post or a
cast post and core (Cpc), and 12.0- and 7.0-mm post
lengths. Each 3D model was imported using *.STEP files
to the finite element software for mesh generation. The
models were subjected to 100-N oblique loading at the
palatal surface, and the results were evaluated by von
Mises criterion and maximum principal stress distribu-
tion. Results: Finite element analysis showed that the
Cpc models showed elevated stress levels in the root ca-
nal regardless of the presence of a ferrule. Relined glass
fiber post models showed homogeneous stress distribu-
tion to the dentin external surface similar to the sound
tooth model. Without a ferrule, Cpc with a 7- or 12-
mm length promoted high levels of tensile stress inside
the root canal. Conclusions: Ferrule presence promoted
more satisfactory stress distribution to the roots. Post
length influenced the stress distribution only for the
models restored with a cast post and core. High levels
of tensile stress inside the root canals were verified
with a cast post and core, which should be avoided to
rehabilitate weakened roots, mainly in the absence of
a ferrule. (J Endod 2014;40:1874–1878)
E ndodontically treated teeth are highly affected by the risk of biomechanical failure
compared with sound teeth (1–4). The rehabilitation of root-filled teeth demanding
intraradicular retention is related to several factors such as quantity and quality of
dentin walls (5, 6), post system, post cementation length (7, 8), presence of a
ferrule (1, 9, 10), and final restoration (2, 6). In some situations, root canals can
become weakened and flared because of the progression of caries on the root
canals associated with endodontic access and overpreparation (2). Because of this pro-
cess, the resulting flared root canals have thin root dentin walls, which may be too weak
to resist physiologic occlusal loading, thus becoming more susceptible to the fatigue
process and fractures (11, 12). This fact makes the restorative procedure of these
teeth more difficult. Therefore, the rehabilitation of weakened root-filled teeth has
been recognized as a challenge by several authors (2, 12–14).
The correct choice of the post system used for weakened teeth rehabilitation and
the ferrule effect are crucial for prognosis and longevity of the treatment (15, 16).
Traditionally, flared teeth have been restored using cast metal posts and are often
unsuccessful because of a lack of retention (14). Moreover, rigid materials like the
different alloys used in cast posts and cores may increase the risk of vertical root frac-
tures (17–20). On the other hand, glass fiber posts have similar mechanical properties
to dentin but also present standardized geometry and cannot be well adapted to flared
root canals. This fact can result in a thick line of resin cement, affecting the bond
strength and fracture resistance of the restorative complex (11, 13, 21, 22).
However, the development of new post surface treatment techniques improved bond
strength between composite resins and glass fiber posts (23, 24). Thus, glass fiber
posts can be relined with composite resin previous to cementation in flared root
canals, contributing to a reduced volume of luting cement and a better fit to the root
canal (22, 25).
Nevertheless, the effect of the interaction among ferrule presence, post system, and
post length regarding the biomechanical behavior of weakened root-filled teeth is still
unclear. The hypothesis tested was that the biomechanical behavior expressed by the
stress distribution would not be affected by the presence of a ferrule, post type, and
post length.

Key Words Materials and Methods

Cast post and core, flared teeth, glass fiber post, stress
distribution
3-dimensional Finite Element Method
An extracted sound maxillary central incisor was scanned by a contact scanner for
acquisition of the external morphology data (MDX-40; Roland Co, Osaka, Japan). The
external anatomy of the enamel and root dentin was recorded through 0.2-mm readings

From the Departments of *Restorative Dentistry and Dental Materials and†Occlusion, Fixed Prosthodontics and Dental Materials, Dentistry School, Federal University
of Uberlandia, Minas Gerais, Brazil; ‡Renato Archer Information Technology Center, Ministry of Science and Technology, Campinas, S~ao Paulo, Brazil; and §Department
of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, S~ao Paulo, Brazil.
Address requests for reprints to Dr Paulo C
esar Freitas Santos-Filho, Biomechanics Research Group, Federal University of Uberl^andia, School of Dentistry, Avenida
Par
a, 1720, Bloco 4L, Anexo A, Sala 34, Campus Umuarama, Uberl^andia, Minas Gerais, Brazil 38400-902. E-mail address: paulocesarfs@foufu.ufu.br
0099-2399/$ - see front matter
Copyright ª 2014 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2014.07.015

1874 Santos-Filho et al. JOE — Volume 40, Number 11, November 2014

and stored in stereolithography files in a computer connected to the scan-
ner with the proper software (3D Bundle; Roland, Irvine, CA). After ob-
taining the external geometry of the enamel and root, chemical
degradation of the enamel was performed for coronal dentin exposure.
The root was protected with utility wax, and the crown was immersed in
10% hydrochloric acid solution contacting only the enamel, thus prevent-
ing wear of the root dentin. Afterward, scanning was performed again,
and the external geometry of the coronal dentin was obtained. For gen-
eration of the dental pulp geometry, the tooth was sectioned longitudi-
nally in the mesiodistal direction using a precision saw (Isomet 1000;
Buehler, Lake Bluff, IL), and the geometry of the pulp chamber and
root canal was generated according to their contour. The stereolithogra-
phy files generated were imported to computer-aided design (CAD) soft-
ware (Rhinoceros 3D 4.0; McNeel North America, Seattle, WA). On the
basis of this file, nonuniform rational Bazier spline surfaces and solids
were created. Completing the generation of the sound model, the support
of the tooth was designated with the periodontal ligament and root
embedment in an acrylic resin cylinder, simulating the conditions of lab-
oratory studies (Supplemental Figure S1 is available online at www.jen-
dodon.com) (26).
After the generation of the sound model, 4 flared dentin root ca-
nals were created using the same biological CAD techniques. All root
models were prepared to leave a 0.5-mm-thick cervical dentin wall
with a 2.5-mm diameter at the apex after post space preparation. The
roots were also prepared with and without a 2-mm ferrule. Finally, using
Boolean operations, the flared post space was created with 2 lengths:
7 and 12.0 mm. A total of eight 3-dimensional numeric finite element
models were created according to ferrule presence, post system, and
length as follows: models with ferrule and without ferrule and models
with a relined glass fiber post (Gfp) or a cast post and core (Cpc) with
post lengths of either 7.0 or 12.0 mm. The models restored with a re-
lined glass fiber post were generated with a composite resin layer
around the retainer in order to fill out the weakened root canal. All
models were restored with an all-ceramic full crown.
Afterward, the models were exported in *.STEP files to computer-
aided engineering software (Femap 10.1 [Velocity Series], Siemens
PLM Software, Plano, TX), and meshing of each structure was per-
formed using solid quadratic tetrahedral elements of 10 nodes
(Fig. 1A). A total load of 100 N was applied at a 135 angle with the
longitudinal tooth and a nodal displacement constraint applied at the
bottom and lateral surfaces of the support cylinder (Fig. 1B). Linear
structural analysis was performed, and all materials were considered
linear, isotropic, and homogeneous, except the orthotropic glass fiber
post. The applied mechanical properties, elastic modulus (MPa), and
Poisson ratio were as follows: enamel: 84.1  103/0.33 (17); dentin:
18.0  103/0.31 (18); pulp: 0.02  103/0.45 (19); feldspathic
ceramic: 69  103/0.3 (27); polyether: 50/0.45 (20); polystyrene
resin: 13.5  103/0.31 (20); composite resin: 15.8  103/0.24
(21); Ni-Cr alloy: 205  103/0.33 (22); and glass fiber post (23):
EX: 37000, EY: 9500, EZ: 9500; hXY: 0.34, hYZ: 0.27, hXZ: 0.34;
GXY: 3544.8, GXY: 1456.7, and GXZ: 3544.8 (E = elastic modulus;
= Poisson ratio; G = shear modulus; and X, Y, and Z = specific orthog-
onal plane directions). Models were then exported to the finite element
processing software (NEi Nastran 9.2; Noran Engineering, Westminster,
CA), and the solution of each model was run. Von Mises equivalent
stresses and maximum principal stress (MPS) were determined for
stress assessment.
Results
The analysis of stress distribution was conducted by von Mises
criteria and MPS. Finite element analysis demonstrated that Cpc models
JOE — Volume 40, Number 11, November 2014
Basic Research—Technology
showed elevated stress levels in the root canal regardless of ferrule pres-
ence (Fig. 1E, F, I, and J). High levels of tensile stress inside the root
canal were also observed for Cpc models (Fig. 2A, B, E, and F). On
the other hand, relined Gfp models showed homogeneous stress distri-
bution to the dentin external surface (Fig. 1G, H, K, and L) and related
structures, similar to the behavior found for a sound tooth (Fig. 1C).
A reduction in the post length showed significant differences be-
tween the different retainers in the weakened roots. Regardless of
ferrule presence, the stress distribution of relined Gfp models were
not influenced by the post length (Fig. 1G, H, K, and L). However, the
post length was more deleterious for the Cpc models in which stresses
were concentrated in a smaller area inside the weakened root canal
(Fig. 1F and J). MPS analysis also showed high levels of tensile stress
within the root canal with shorter Cpc posts. The worst condition for
stress distribution was observed for the Cpc/ferrule/12 and 7 mm
models (Fig. 2E and F).
Ferrule presence was important for both post systems used for the
rehabilitation of flared teeth. The use of Cpc associated with the absence
of a ferrule created a high stress concentration in all post extension
buccal or lingual surfaces inside the thin root canal (Fig. 1I). In addi-
tion, this model also showed more tensile stress concentration
compared with other models (Fig. 2E). Shorter posts resulted in
increased tensile stresses at the root dentin (Fig. 2F and H).
Discussion
Finite element analysis is an important engineering tool to pre-
dict and understand the stress and strain behavior of the materials
(28). This method seems well suited for the analysis of dental mate-
rials and structures because it is capable of performing numeric anal-
ysis transforming a real problem on virtual. Using mesh generation
that follows the geometry of the structures, the resolution of complex
equations becomes possible through a variety of simple equations.
The mesh elements represent the discretization of the physical model,
and each element is characterized by the mechanical properties of the
materials, making it possible to solve complex problems. The stresses
are represented by the failure criteria that convert the results in color
maps according to a predefined scale. The results of the present study
were evaluated by von Mises equivalent stress and MPS. Von Mises
stress is a failure criterion that shows the energy transmission in
the structure (ie, where there is a higher concentration of energy),
whereas MPS discriminates the tensile (positive) and compressive
(negative) stress fields. Dental materials and structures have high
compressive strength but are brittle when subjected to tensile stresses
(29). Thus, MPS shows the locations of the structure that are more
prone to failure by tensile stress (20). In the evaluation of very
weak structures, like flared root-filled teeth, MPS is a very powerful
criterion to find the possible critical failure points at the dental
structure.
The hypothesis tested was rejected. Ferrule presence, post type,
and post length influenced the stress distribution of the root-flared
teeth. In this study, the relined Gfp simulated showed better stress dis-
tribution than Cpc, which showed a high stress concentration inside the
root canal (Fig. 1E, F, I, and J). The flared root canal proved to be a
critical factor in the restoration of endodontically treated anterior teeth
because it increased the stress concentration in a small volume of root
dentin, consequently increasing the risk of root fractures. Several
studies also reported this fact (11, 12, 25, 30). Ferrule presence
influenced positively the stress distribution, regardless of the post
system. Ferrule absence accentuated the stress concentration in the
weakened roots for both post systems. A ferrule is defined as a 360
metal collar of the crown surrounding the parallel walls of the dentin
Finite Element Analysis of Weakened Root-filled Teeth 1875
Basic Research—Technology

Figure 1. (A) Finite element mesh. (B) Load and boundary conditions. (C) Stress distribution by von Mises criteria of sound incisor. (D) Stress distribution by
MPS of a sound incisor. Stress distribution by von Mises criteria of experimental models: (E) Cpc/12 mm/ferrule (F), (F) Cpc/7 mm/F, (G) Gfp/12 mm/F, (H) Gfp/7
mm/F, (I) Cpc/12 mm/without a ferrule (AF), (J) Cpc/7 mm/AF, (K) Gfp/12 mm/AF, and (L) Gfp/7 mm/AF.

1876 Santos-Filho et al. JOE — Volume 40, Number 11, November 2014

Figure 2. Stress distribution by MPS: compressive stress (blue: 50 MPa) and tensile stress (red: 50 MPa). (A) Cpc/12 mm/F, (B) Cpc/7 mm/F, (C) Gfp/12 mm/
F, (D) Gfp/7 mm/F, (E) Cpc/12 mm/AF, (F) Cpc/7 mm/AF, (G) Gfp/12 mm/AF, and (H) Gfp/7 mm/AF.
(10). This increases the fracture resistance (20) and protective effect by
reducing the stresses, as we observed in this study.
One of the most decisive factors in the choice of a post system is
related to the post length. Several studies reported success in the reha-
bilitation of endodontically treated teeth when the post length was equal
to or greater than the crown length (31, 32), whereas for a short post
length, a high rate of root fractures was found (33). Santos-Filho et al
(7, 8) reported that the length of metallic posts is directly related to the
fracture resistance of endodontically treated teeth. In this study, finite
element analysis showed that the stress distribution of cast posts and
cores was negatively influenced by the reduction in the post length.
In addition, the high of the metal alloy used to fabricate the Cpc
increases the rigidity of the restorative complex (20). This stiffness is
related to the high stress concentration in the thin dentin wall for the
weakened tooth. Then, when the restorative complex fails by fatigue
mechanisms, the stresses are transferred to dentin, causing vertical
root fractures (19).
In the absence of a ferrule, the weakened root canal associated
with the use of a shorter Gfp showed a stress concentration at the inter-
face between the resin composite and the Gfp. This fact may affect this
adhesive interface leading to post debonding and resin core fractures,
resulting in bacterial colonization and periapical lesions (34). Thus, the
JOE — Volume 40, Number 11, November 2014
Basic Research—Technology
post should be as long as possible for the rehabilitation of teeth with
weakened roots. The use of glass fiber posts to restore weakened roots
seems to be the best choice because the stress fields observed in this
study were similar to the sound tooth model. The use of a Gfp also
can be justified in accordance with the findings of Santos et al (35),
who reported that teeth restored with a Gfp are less likely to fail because
the risk of fractures occurs in the composite core and/or it is higher in
the post than in the root. Verissimo et al (20) also showed that the as-
sociation of ceramic crowns and Gfps can create an protective effect on
the dental structure, mainly on the presence of a ferrule. This is because
a low elastic modulus of a Gfp in association with a ceramic prosthetic
crown and the adhesive integration achieved between the ceramic, resin
core, and resin cement creates a flexible restorative complex with me-
chanical properties closer to sound teeth.
Because this study was conducted exclusively with computational
simulations, it presented some intrinsic limitations. Future in vitro
studies with fracture resistance tests, strain gauge measurements, and
thermal and mechanical cyclic loadings are needed for better compres-
sion of the biomechanical behavior of weakened root teeth. However,
the findings of the present investigation reveal that the correct determi-
nation of the post material and length associated with conservation of
the dental structure are essential to the longevity and clinical success
Finite Element Analysis of Weakened Root-filled Teeth 1877
Basic Research—Technology
of the rehabilitation of weakened endodontically treated anterior teeth.
Within the limitations of this finite element analysis, it was concluded
that the presence of a ferrule is a determining factor on the stress dis-
tribution of the weakened teeth. The use of fiberglass posts relined with
resin composite should be a conservative choice to restore flared roots
compared with cast posts and cores because of the stress distributions
observed. The biomechanical performance, expressed by stress distri-
bution, showed that a relined Gfp post was less sensitive to post length;
however, it should be used as long as possible. Cast posts and cores ex-
hibited high levels of tensile stress inside the root canal and should be
avoided to rehabilitate weakened roots.
Acknowledgments
Supported by the National Counsel of Technological and Scien-
tific Development (CNPq) (grant no. 0696860139624802).
The authors deny any conflicts of interest related to this study.
Supplementary Material
Supplementary material associated with this article can be
found in the online version at www.jendodon.com (http://dx.doi.
org/10.1016/j.joen.2014.07.015).
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