Operative Dentistry, 2008, 33-3, 305-311
A Study of the
Fracture Resistance of Nyyar Cores
of Three Restorative Materials
S Ferrier • BS Sekhon • PA Brunton
Clinical Relevance
The fracture resistance of resin-modified glass ionomer cements merits consideration of their
use as core materials for root-filled premolars.
SUMMARY
Despite the successful use of dental amalgam for
coronal-radicular dowel and core build-up in
endodontically-treated posterior teeth, newer
materials offer many potential advantages over
amalgam and have better patient acceptance.
This study compared the fracture resistance of
coronal-radicular restorations made from three
different direct restorative materials. Sixty
human premolars were selected, 45 of which
were root treated and decoronated. Fifteen of
these premolars were restored using amalgam,
15 with composite and 15 using resin-modified
glass ionomer. The 15 unrestored teeth were
used as a control group. All the teeth were
mounted in acrylic within steel containers and
subjected to compressive loading to failure on a
Stephen Ferrier, PhD, BDS, FDSRCS (Edin), Dept of Restorative
Dentistry, Leeds Dental Institute, Leeds, UK
Balraj S Sekhon, BDS, dental practitioner, Stockport, Cheshire,
UK
*Paul A Brunton, PhD, MSc, BChD, FDS (Rest Dent) RCS (Edin),
Dept of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
*Reprint request: Clarendon Road, Leeds LS2 9LU, UK; e-mail:
p.a.brunton@leeds.ac.uk
DOI: 10.2341/07-90
universal testing machine. The force required to
fracture each core specimen was recorded as
well as the proportion of core lost due to failure.
The results showed dental amalgam as having
the highest fracture resistance (mean 1.93kN, sd
0.22) followed by resin-modified glass ionomer
(mean 1.05kN, sd 0.20), sound tooth (mean
0.79kN, sd 0.20) and composite (mean 0.75kN, sd
0.11). The differences among all groups were sig-
nificant. These results demonstrate that,
although resin-modified glass ionomer is signifi-
cantly weaker than amalgam, these restorations
were stronger than unrestored teeth and failed
at forces in excess of those encountered in nor-
mal mastication. Amalgam cores, along with
resin-modified glass ionomer, tended to fail less
catastrophically than the other materials and,
given their strength, would remain the material
of choice in situations where abnormally high
forces are expected.
INTRODUCTION
The different properties of core materials and their
various applications have been extensively reported in
the dental literature. In particular, a technique of coro-
nal-radicular stabilization of endodontically-treated
posterior teeth with amalgam has been widely report-
306
ed. Using this technique, Nayyar and others reported
400 successful restorations when cast crowns were
placed as the final restoration.1 Amalgam has many
favorable properties, which include high compressive
strength and dimensional stability in the oral environ-
ment. Amalgam has been used successfully as a final
restoration to replace tooth tissue in bulk in root-treat-
ed posterior teeth.2 However, this material does have
disadvantages—poor color, low initial strength, lack of
inherent bond to tooth structure and a high coefficient
of thermal diffusivity.3 In addition, there has been
much controversy regarding its alleged harmful effects
on systemic health, although these effects have never
been scientifically proven.4 Alternatives to amalgam,
with different useful attributes, are now available and
include fluoride release, pleasing aesthetics, adhesion
to tooth structure, command cure, choice of curing
methods and desirable handling properties. Against
this backdrop, patients are increasingly requesting bio-
compatible metal-free restorative systems.
Both resin composite and glass-ionomer cements
have been advocated as alternative core build-up mate-
rials to amalgam. Resin composites offer an advantage
over amalgam in that the material can be rapidly poly-
merized at the chairside and, therefore, prepared at
the same visit. In addition, resin composites possess
the property of adherence to tooth substance via the
use of dentin adhesive systems. Disadvantages associ-
ated with the use of resin composites include polymer-
ization shrinkage, microleakage and inferior mechani-
cal strength. Glass ionomers, too, have many favorable
characteristics, including self-adherence to tooth tis-
sue, fluoride release and a favorable coefficient of ther-
mal expansion. As a group of materials, glass ionomers
have disadvantages that limit their use in core build-
up applications; these include a lack of inherent
strength, brittleness and unfavorable setting and mat-
uration characteristics. Some improvement is possible
with the incorporation of stainless steel powders, sil-
ver/tin alloy fibers or flakes and by high temperature
sintering of silver and glass powders, although
enhancement of physical properties by these means is
marginal.5-6 In a study comparing the mechanical prop-
erties of direct core build-up materials, Combe and oth-
ers concluded that cermets were not particularly suit-
able for this application, although they noted that cer-
mets appeared to have a good clinical success rate.7
Glass ionomers incorporating hydrophilic resins are
known as resin-modified glass ionomer cements
(RMGIC) or hybrid ionomers. The methacrylate com-
ponents are polymerizable by light curing, allowing
command set of the material in addition to the acid-
base reaction of a conventional glass ionomer. These
materials benefit from having fluoride release and
recharge characteristics similar to that of glass
ionomer.8 These are chemically complex materials and
Operative Dentistry
are not fully understood. It has also been shown that
the physical properties of resin-modified glass
ionomers are affected by the presence of moisture.9
Various post-core systems have been compared:
Gelfand and others10 and Hoag and Dwyer11 demon-
strated no significant difference in the fracture force
between cast post and cores and amalgam corono-
radicular restorations treated with cast crowns. A
study conducted by Howdle and others showed that
different bonding agents could be utilized to improve
the success rate of corono-radicular cores by prevent-
ing microleakage around the restoration.12 However,
conflicting results, published by Kern and others,
revealed that corono-radicular restorations had signif-
icantly lower mean fracture loads compared to post-
retained amalgam cores when used as a core for a cast
crown.13
The strength of core materials is an important fea-
ture that has received much attention. A core is usual-
ly required to replace a large bulk of tooth structure
and, therefore, must resist multidirectional masticato-
ry forces for many years. Bonilla and others compared
the fracture toughness of several core materials and
found that amalgam and composite were able to with-
stand stresses generated during mastication.14 These
findings were consistent with the results of Cho and
others15 and Gateau and others,16 both of whom found
that some composites exhibited compressive strengths
equal to that of amalgam and could be used as alter-
natives to amalgam. In contrast, glass ionomer
cements are not regarded favorably as suitable core
materials in areas of the oral cavity subjected to stress-
es. Cho and others found that GIC materials were
markedly weaker than resin composites and amal-
gams. Similarly, Engelman also concluded that GICs
should be used cautiously as core build-up materials.17
Combinations of these core materials with different
post-retention systems have displayed similar results.
In addition to strength, there are many other charac-
teristics that influence the choice of one core material
over another. Oliva and others investigated the dimen-
sional stability of silver amalgam and a conventional
composite. These researchers found that amalgam
used as a core material is more dimensionally stable
than composite when exposed to moisture.18-19 In these
studies, the dimensional instability of composite cores
due to water sorption was reported to have significant-
ly affected the seating of cast restorations. In contrast,
a study by Vermilyea and others found no significant
difference between the seating of cast restorations on
natural tooth cores and composite cores that had been
exposed to moisture. In addition, this article suggests
that well-fitting provisional restorations may minimize
this problem.20 The effect of thermal changes on core
materials has also been studied. Yang and others found
that non-metallic dowel and core materials generated
Ferrier, Sekhon & Brunto: A Study of the Fracture Resistance of Nyyar Cores of Three Restorative Materials 307

greater thermal stresses than their metallic equiva- Restoration (Groups I—III)
lents. These stresses may cause fracture of the dental Gutta-percha was removed to a depth of 3 mm from
structure or leakage of the restoration, ultimately each canal with a size IV Gates-Glidden bur in a slow
resulting in restoration failure.21 speed handpiece. Natural undercuts in the pulp cham-
This study determined the suitability of three core ber wall were retained in order to assist with core
materials for coronal-radicular build-up by measure- retention. A stainless steel Siqveland matrix band was
ment of fracture resistance of these restorations in custom fitted to each prepared tooth prior to core build-
root-filled premolars in vitro under compressive load up. After core build-up, all the teeth were then stored in
and compared these to a group of unrestored teeth. distilled water for 24 hours prior to testing.
The following core build-up materials used were:
METHODS AND MATERIALS
Group I Amalgam: Tytin FC fast-set silver
Sixty sound, intact, extracted maxillary first premolars
amalgam (Kerr/Sybron, Orange, CA,
were collected and stored in distilled water. They were
USA)
then randomly divided into four groups, each compris-
ing 15 teeth: Group II Resin composite: Concise resin com-
posite (3M ESPE, St Paul, MN, USA)
• Group I Amalgam core
Group III Resin-modified glass ionomer cement
• Group II Resin composite core
(RMGIC): Vitremer resin-modified
• Group III Resin-modified glass ionomer core glass ionomer cement (3M ESPE, St
• Group IV Sound tooth (control group) Paul, MN, USA)
Root Canal Preparation (Groups I—III) All materials were manipulated according to the
manufacturers’ specifications. The general form of
The teeth were decoronated to a level 1 mm above the tooth preparation and restoration used in Groups 1
cemento-enamel junction (CEJ) and any remaining through 3 are shown in Figure 1.
soft tissue deposits were removed. Access to the pulp
chambers was gained using a high-speed handpiece Group 1: Amalgam Corono-radicular Core Technique
and a friction-grip tapered bur. Subsequently, using a The amalgam was triturated according to the manu-
slow-speed handpiece, a Meisinger pulp chamber bur facturer’s guidelines using an amalgamator.
(Hager & Meisinger GmbH, Neuss, Germany) was Condensation was then commenced immediately, with
used to remove the roof of the pulp chamber, where the amalgam packed first into the root canal space,
necessary, and also eliminate overhanging dentin. then built to a height of 4 mm above the CEJ. Following
Following access to the pulp chamber, the root canals this procedure, the matrix band was carefully removed
were identified and coronal preparation commenced and the occlusal surface of the core was carved to an
with Gates-Glidden burs. A size 15 file was then intro- anatomic form.
duced into each canal until it was seen to protrude
from the apex and the working length
ascertained by subtracting 1 mm from
this measurement. The root canals
were prepared to a file size 30 and
stepped back with files 35 and 40 to
produce an apical taper. Upon comple-
tion of the preparation, the canals
were dried with sterile paper points
and coated with Tubliseal root canal
sealer (Kerr/Sybron, Orange, CA,
USA). A cold lateral condensation tech-
nique was used to obturate the teeth;
this technique involved placement of a
size 30 gutta-percha point at the full
working length and additional accesso-
ry points. Excess gutta-percha was
removed at the base of the pulp using
a hot “plastic” instrument, and the
coronal end of the filling was condensed
into the root canal orifice.
Figure 1: Diagram of tooth preparation and restoration.
308
Figure 2: Diagram showing scoring criteria for modes of core failure.
Group 2: Resin Composite Corono-radicular Core
Technique
Both enamel and dentin were etched with 37% ortho-
phosphoric acid for 30 and 15 seconds, respectively,
then a bonding agent was applied according to the man-
ufacturer’s recommendations (Concise Enamel Bond,
3M ESPE). A chemically cured resin composite materi-
al was mixed, again according to the manufacturer’s
guidelines. The core material was initially injected into
the root canals before incremental placement of subse-
quent material. Two minutes after placement, the
matrix band was carefully removed and contouring
commenced. The core was built to a height of 4 mm
above the cemento-enamel junction.
Group 3: Resin-modified Glass Ionomer Cement
Corono-radicular Core Technique
Primer was applied to the enamel and dentin for 30 sec-
onds, after which it was air-dried and light cured for 20
seconds. RMGIC was then mixed according to the man-
ufacturer’s instructions by adding equal proportions of
powder and liquid. The material was injected into the
Table 1: Mean Applied Failure Load and Standard Deviations
Group Mean Fracture Load (kN)
I (Amalgam) 1.94
II (Composite) 0.75
III (RMGIC) 1.05
IV (Unrestored) 0.79
Operative Dentistry
root canal preparations, and the core was subsequently
built to a height of 4 mm above the CEJ. The material
was light cured in bulk for 40 seconds. After removal of
the matrix band, the core was contoured using a high-
speed handpiece and composite finishing burs.
Testing
All the teeth were mounted in stainless steel molds
with a self-curing acrylic resin to a depth of 2 mm api-
cal to the CEJ. The teeth were then loaded to failure in
a Howden Universal Testing Machine (RDP Howden
Ltd, Leamington, UK) using a 4.5 mm diameter stain-
less steel rod placed in the midline fissure at a
crosshead speed of 0.5 mm/minute. The fracture force
(kN) was recorded for each specimen, and the mode of
failure was recorded using a system previously
described for teeth restored with dentin bonded
crowns.22 The score assigned to each type of failure is
shown in Figure 2. The results were analyzed using a
one-way analysis of variance (ANOVA) and Bonferroni’s
test at a 5% level of significance (p=0.05). A non-para-
metric test was used to interpret the data representing
the modes of failure of the different core materials.
RESULTS
The collected data was compiled and analyzed using the
SPSS 10.1 statistical package. One-way ANOVA and
Bonferroni’s test revealed significant differences in the
fracture resistance of the core materials at the 5% level
of significance. Values for the mean fracture resistance
of each material are presented in Table 1.
The mean (sd) fracture resistance (kN) obtained for
the amalgam cores was 1.94 (0.22), which was greater
than that obtained for the cores constructed from resin
composite 0.75 (0.11), resin-modified glass ionomer
cement 1.05 (0.2) and the controls 0.79 (0.2).
Furthermore, multiple comparisons performed using
the Bonferroni’s test revealed that significant differ-
ences in fracture resistance existed among all the mate-
rials except the composite and control groups, which
were similar.
The mode of fracture of the core materials was ana-
lyzed using non-parametric statistical tests. Cross tab-
ulation of the results revealed the proportion of teeth in
each group which fell into each mode of failure subdivi-
sion. The data are presented in Table 2, where it can
clearly be seen that a higher proportion of the amalgam
core failures constituted minimal fractures (66.7%) in
Std Dev 95% Conf Int Range (kN)
0.22 1.86 - 2.06 1.67 - 2.47
0.11 0.69 - 0.81 0.61 - 0.95
0.20 0.94 – 1.16 0.67 – 1.37
0.2 0.67 – 0.90 0.49 – 1.29
Ferrier, Sekhon & Brunto: A Study of the Fracture Resistance of Nyyar Cores of Three Restorative Materials
Table 2: Modes of Failure by Restoration Type
Group/Mode 1 2
of Failure
I (Amalgam) 10 (66.7%)
II (Composite) 0 7 (46.7%)
III (RMGIC) 5 (33.3%)
IV (Unrestored) 0 15 (100%)
comparison to the other materials. Resin composite
core materials exhibited more severe fractures, with a
high proportion of failures involving greater than half
of the core (53%). It can also be seen that all the control
teeth failures occurred in a similar manner (Figure 2,
Code 2 failure—fracture involving less than half the
core). This finding was supported by the Mann-
Whitney tests, which were used to compare the mode of
failure of one core material against another. Significant
differences in the mode of failure were found among all
the materials except for amalgam and resin-modified
glass ionomer cement (RMGIC), and RMGIC and the
controls.
DISCUSSION
This study compared the fracture resistance of three
different core materials against the fracture resistance
of a sound tooth. This is clinically relevant, because
strength in terms of fracture resistance is regarded as
a critical indicator of success due to the masticatory
and parafunctional forces that a core is subjected to.
Prior to testing, tooth preparation and core build-up
techniques were largely influenced by the findings of
previous studies. Nayyar and others recommended
that gutta-percha be removed to a depth of 2 to 4 mm
in each canal and that the remaining pulp chamber
should be of an adequate width and depth to provide
retention for the core material.1 Kane and others found
that the extension of amalgam into the root canal
space was beneficial only when the pulp chamber
height was 2 mm.23 Therefore, this study attempted to
conform to recommendations from previously acknowl-
edged publications wherever feasible. Previous studies
measuring fracture resistance have used 5 to 10 teeth
in each group;10-11,13,23-25 however, in the current study, 15
teeth were used in each group, because of the potential
variability introduced by tooth anatomy, core geometry
and surface finish.
Analysis of mean fractural resistance values
revealed that amalgam was better able to resist frac-
ture when subjected to a compressive load; whereas,
composite was least able (Table 1). The cores con-
structed from resin-modified glass ionomer cement
ranked second behind amalgam (mean fracture
strength 1.05 kN). The significance of these findings
was determined by a one-way ANOVA test, where
p=0.05. Similarly, amalgam core failure proved to be
309
3 4
4 (26.7%) 1 (6.7%) 0
7 (46.7%) 1 (6.7%)
8 (53.3%) 1 (6.7%) 1 (6.7%)
0 0
much less severe in comparison to the resin composite
material. However, Mann-Whitney statistical testing
revealed no significant differences between amalgam
and RMGIC in the mode of failure. The control group,
comprising sound, unmodified teeth, exhibited a mean
fracture strength of 0.79 kN, and these teeth were con-
sistent in their mode of failure (Figure 2, code 2).
Interestingly, all values for fractural strength exceed-
ed the mean maximal clenching force of healthy
patients with natural teeth, which is reported to aver-
age up to 162 pounds (equivalent to 721 N). Indeed,
biting force is generally less between premolars,
around 310N.26 However, this is highly variable
between subjects of different ages and sex and is
dependent upon the manner in which it is measured.27
Analysis of the results also revealed that the cores
constructed from resin-modified glass ionomer cement
had a significantly higher fracture resistance than
composite cores and exhibited less severe failure. This
result would appear anomalous from consideration of
the headline mechanical properties of the two materi-
als. Resin composite has been shown to have greater
fracture toughness,14 compressive, flexural and diame-
tral tensile strength than RMGIC.15 However, resin
composite possesses several features that may have
been a disadvantage in this setting. In a study of crack
propagation, composite was shown to have high crack
propagation rates arising from a notional 1 µm surface
defect compared to other restorative materials. It has
been shown that composite exhibits high stresses at
the point of contact, and it is suggested that this may
explain catastrophic bulk failure observed in clinical
usage.28 In addition, the presence of air-voids, unbond-
ed filler particles and any contaminants all act as sites
for crack growth. This may explain the findings of the
current study, where the method of force application
would almost certainly have stressed small areas of
the samples, the finishing technique may have left sur-
face defects and the two-paste system may have pre-
disposed to air void inclusion. In contrast, RMGIC has
been shown to exhibit high compressive toughness.29
Water sorption has been shown to progress through
this material rapidly in the first 24 hours; in addition,
the mechanical properties of this material mature over
a period of months.9,30 In the current study, samples
were freshly made and stored in distilled water for 24
hours prior to testing. This material is plasticized by
310
water sorption, increasing its viscoelastic and plastic
properties. This leads to softening of the surface, which
may have allowed reduced stress concentration by
increasing the area of contact. In combination with a
concomitant decrease in flexural modulus and an
increase in the degree of deformation before fracture,
this may have maximized the plastic properties of the
material, giving a softer, more compliant material,
allowing it to better resist fracture. Interestingly,
amalgam also behaves in a similar viscoelastic man-
ner. Stress relaxation properties in both these materi-
als, aided by a relatively low strain rate in this study,
may help to explain why both cores resisted fracture
better than composite, yet failed in a similar, less cat-
astrophic manner.
The variables that are inherent with research of this
type are tremendous. Consequently, this study could
be considered to suffer some limitations that merit fur-
ther discussion. First, the acrylic resin supporting the
teeth and the force of the Howden Universal testing
machine do not fully simulate the clinical situation, as
there is no allowance for an artificial periodontium.
Each core reconstruction was standardized to a height
of 4 mm above the CEJ and prepared with two inclined
planes (facial and lingual) and a central parallel
groove. Reproduction of the occlusal surface was large-
ly performed freehand and, therefore, introduced geo-
metric variation between cores; however, efforts were
made to minimize variation. The control teeth were
left unprepared and problems associated with this
became apparent upon testing. Wedging forces direct-
ed against the cuspal inclines may have resulted in
premature fracture and consequently have affected the
results obtained. Furthermore, the teeth were not
restored with full coverage cast restorations. Despite
these limitations, the results of this study provide
valuable information about the fracture resistance of
the three core materials investigated. This is increas-
ingly relevant as practitioners choose to delay, some-
times indefinitely, the provision of a cuspal-coverage
type restoration. It is suggested that further discus-
sion of the suitability of the materials tested for the
restoration of root-treated posterior teeth is timely.
CONCLUSIONS
Within the limitations of this study, it may be conclud-
ed that there are significant differences in the fracture
resistance of the three core materials tested.
Endodontically-treated premolars restored with amal-
gam corono-radicular restorations exhibited greater
fracture resistance compared to equivalent teeth
restored with composite and resin-modified glass
ionomer cement.
(Received 8 May 2007)
Operative Dentistry
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