journal of the mechanical behavior of biomedical materials 133 (2022) 105309

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Journal of the Mechanical Behavior of Biomedical Materials

journal homepage: www.elsevier.com/locate/jmbbm

Biomechanical behavior of endodontically treated premolars restored with

different endocrown designs: Finite element study
Mostafa Aldesoki a, *, Christoph Bourauel a, Tarek Morsi b, Mohamed I. El-Anwar c, Ahmad
K. Aboelfadl a, b, 1, Tarek M. Elshazly a, 1
a
Oral Technology, Dental School, University Hospital Bonn, Bonn, Germany
b
Department of Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
c
Department of Mechanical Engineering, National Research Centre, Giza, Egypt

A R T I C L E I N F O A B S T R A C T

Keywords: Purpose: Although endocrown is a successful restorative approach for endodontically treated molars, its survival
Endocrown rate in endodontically treated premolars with extensive loss of coronal structure has been debated. The aim of
Premolar this study was to evaluate the biomechanical behavior of endodontically treated maxillary premolars restored
Finite element analysis
with different lithium disilicate endocrown designs.
IPS e.max CAD
Materials and methods: Based on cone-beam computed tomography (CBCT) of an intact maxillary premolar, five
Dental biomechanics
Prosthodontics models were designed. Model A: fiber post, core, and crown; Model B: endocrown, 5 mm pulpal extension and
butt margin; Model C: endocrown, 5 mm pulpal extension and axial extension; Model D: Endocrown, 3 mm
pulpal extension and butt margin; Model E: Endocrown, 3 mm pulpal extension and axial extension. The bone
geometry was simplified as a cylinder of compact and trabecular bone. All models were imported into finite
element analysis (FEA) software, where the base of the bone cylinder was chosen as fixed support. Axial and
oblique loads of 100 N each were applied separately to each model, and static structural analysis was performed.
Results: Regardless of the design of the endocrown, the resulting von Mises stresses were far below the yield
strength of the tooth structure and the flexural strength of the ceramic material. The generated von Mises stresses
on the restoration decreased by 15% in the models with 3 mm pulp extension (D and E) compared to the 5-mm
pulpal extension models. In addition, the resulting von Mises stresses on the tooth structure decreased also by
15% in models C and E with the axial extension compared to models B and D with the butt margin.
Conclusion: Endocrown is a suitable restoration for endodontically treated maxillary premolars. Furthermore,
reducing the depth of the pulpal extension to 3 mm with the addition of an axial extension resulted in a more
favorable stress distribution within the tooth-restoration interface.

1. Introduction nonvital teeth more susceptible to fracture (Chang et al., 2009).

Rehabilitation of severely damaged endodontically treated teeth is a
major challenge in restorative dentistry. Furthermore, clinical concepts
for the restoration of non-vital teeth are based on an extensive and
inconclusive empirical literature. The loss of tooth integrity associated
with caries and extensive cavity preparation is the main reason for the
reduced stiffness of endodontically treated teeth, rather than dehydra­
tion or physical changes in dentin (Huang et al., 1992; Papa et al., 1994;
Reeh et al., 1989; Schwartz and Robbins, 2004). In addition, the lack of
vitality severely limits sensory feedback during peak loads and makes
Restoration of endodontically treated teeth with extensive coronal
damage has always followed a rigorous protocol of fabricating a full-
coverage crown, a core, and a fiber or metal post (Asmussen et al.,
2005; Dietschi et al., 2008; Ma et al., 2009; Zarow et al., 2009). It was
thought that this protocol would provide better reinforcement of the
remaining tooth structure (Hirschfeld and Stern, 1972; Stern and
Hirshfeld, 1973). However, it was found that the use of radicular posts
only improved the retention of the prosthetic crown, while it deterio­
rated the remaining tooth structure at the same time, as intact tooth
structure was removed to allow for the placement of the post (Assif and

* Corresponding author. Oral Technology, University Hospital Bonn, Bonn, Germany, Welschnonnenstr. 17, 53111, Bonn, Germany.
E-mail addresses: mostafadesoki86@gmail.com, aldesoki@uni-bonn.de (M. Aldesoki).
1
These authors have contributed equally to this work and share last authorship.

https://doi.org/10.1016/j.jmbbm.2022.105309
Received 25 April 2022; Received in revised form 31 May 2022; Accepted 2 June 2022
Available online 7 June 2022
1751-6161/© 2022 Elsevier Ltd. All rights reserved.
M. Aldesoki et al.
Gorfil, 1994; Guzy and Nicholls, 1979; Soares et al., 2007; Zamin et al.,
2012).
With the rise of adhesive dentistry, the need for using posts and
filling cores became less obvious. In addition, the advent of ceramics
with high mechanical strength that can be acid-etched (e.g., lithium
disilicate-reinforced ceramics), combined with the adhesive ability of
adhesive systems and resin cement, made it possible to restore posterior
teeth without intra-radicular posts (El-Ma’aita et al., 2022; McLean,
1998). Thus, it became possible to restore posterior teeth with extensive
coronal destruction by using onlay and/or overlay restorations and,
more recently, by endocrowns (Otto, 2004; Pissis, 1995).
The term endocrown was first described by Bindl and Mormann in
1999 as adhesive endodontic crown (Bindl and Mörmann, 1999). These
crowns are anchored in the inner part of the pulp chamber and at the
cavity margins, providing macro-mechanical retention by the pulpal
walls and micro-mechanical retention by adhesive cementation (Chang
et al., 2009).
Although endocrown is a successful restorative approach for
endodontically treated molars, its survival rate in endodontically treated
premolars is still discussed (Al-Dabbagh, 2021; Bindl et al., 2006;
Govare and Contrepois, 2020; Papalexopoulos et al., 2021; Shams et al.,
2022). This could be referred to the smaller bonding surface of pre­
molars compared to molars, which may lead to failure of the cohesive
bond. They also have a greater crown height, which negatively affects
the mechanical properties of the endocrown (Bindl et al., 2006).
Furthermore, only a few studies have investigated the influence of
different preparation designs on the stress distribution at the
tooth-restoration interface. Thus, the aim of this study was to evaluate
the biomechanical behavior of endodontically treated maxillary pre­
molars restored with different endocrown designs using finite element
analysis (FEA).
2. Methods
A maxillary first premolar without any obvious decay was scanned
using a Planmeca ProMax 3D Mid cone-beam computed tomography
(CBCT) machine (Planmeca Inc, Helsinki, Finland). The equipment was
set at 90 kV and an X-ray beam current of 12 mA with a voxel dimension
of 75 μm. The scan duration was 15 s, and a total of 668 slices were
scanned for the modeling. The scanned data were imported into a 3D
image processing and editing software package (Mimics Innovation
Suite, Mimics 14.0/3-matic 7.01; Materialise, Leuven, Belgium) to
create the surface model. In Mimics, masks for enamel and dentin were
created using thresholding and region growing tools. Subsequently, the
Fig. 1. Cone-beam CT of the maxillary first premolar: A) Mesiodistal view. B) Axial view. C) Buccolingual view. D) Segmented 3D model.
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Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
created masks were then used to generate the 3D models of enamel and
dentin, as shown in Fig. 1.
Using the STL + module in Mimics, the 3D models were exported to
3-Matic software and converted into stereolithography triangulated files
(STL) that formed the surface meshes. In 3-matic, five models were
designed derived from the 3D tooth model by performing Boolean op­
erations (volume addition, intersection, or subtraction) as follow: Model
A represented the conventional crown with glass fiber-reinforced post
and a composite core; Model B represented the endocrown with 5 mm
pulpal extension and a butt margin; Model C represented the endocrown
with 5 mm pulpal extension and 1.5 mm axial extension on the buccal
and palatal walls; Model D represented the endocrown with 3 mm pulpal
extension, 2 mm composite seal, and a butt margin; and Model E rep­
resented the endocrown with 3 mm pulpal extension, 2 mm composite
seal, and 1.5 mm axial extension on the buccal and palatal walls (Fig. 2).
The bone geometry was simulated as a cylinder consisting of an inner
part representing the trabecular bone and an outer shell of 1 mm
thickness representing the cortical bone (Fig. 3). Afterwards, all geom­
etries were imported into ANSYS workbench software (ANSYS work­
bench 14.0, ANSYS Inc., Houston, USA) in CDB file format for FEA. In
ANSYS Workbench, the volume mesh was generated based on ‘Solid187’
10-node linear tetrahedral elements with a maximum element size of
0.5 mm. The total number of nodes and elements is shown in Table 1.
The material properties were then assigned based on the elastic
modulus and Poisson’s ratio. The material properties of enamel, dentin,
bone, and restorative materials were assumed to be linear, elastic, ho­
mogeneous, and isotropic. Lithium disilicate-reinforced glass-ceramic
(IPS e.max CAD, Ivoclar Vivadent AG, Liechtenstein) was the material of
choice for both the conventional crown and the endocrowns. The fiber
post was considered orthotropic because it exhibits different mechanical
properties along the direction of the fibers (x-direction) and along the
other two normal directions (y- and z-direction). The material properties
(modulus of elasticity and Poisson’s ratio) of the individual materials are
listed in Table 2. Bonded contact interactions were assumed between the
tooth structure and the restorations, simulating the use of adhesive
luting cement.
As a boundary condition, the base of the cylinder of the cortical bone
was chosen as a fixed support in all directions. Two loading cases were
applied to simulate the normal occlusion: An axial nodal force of 100 N
parallel to the long axis of the tooth, which was evenly distributed ac­
cording to literature among three contact points, namely the mesial
marginal ridge, the distal marginal ridge, and the tip of the palatal cusp
(Nelson and Ash, 2010). Each point consisted of 10 selected nodes
(Fig. 4A), and an oblique nodal force of 100 N at an angle of 45◦ to the
M. Aldesoki et al. Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309

Fig. 2. Schematic representation of the five designed models: (Model A) Post, core, and conventional crown; (Model B) Endocrown with 5 mm pulpal extension and
butt margin; (Model C) Endocrown with 5 mm pulpal extension and 1.5 mm axial extension; (Model D) Endocrown with 3 mm pulpal extension, 2 mm composite
core, and butt margin; (Model E) Endocrown with 3 mm pulpal extension, 2 mm composite core, and 1.5 mm axial extension.

Table 2
Material properties assigned to different objects in the finite element model.
Material Elastic modulus Poisson’s Shear
(GPa) ratio modulus

Enamel (Dejak et al., 2012) 84.1 0.33

Dentin (Dejak et al., 2012) 18.6 0.32
Trabecular bone (Ramos Verri 1.37 0.30
et al., 2015)
Cortical bone (Ramos Verri 13.7 0.30
et al., 2015)
Composite core a 22 0.22
IPS e-max CAD (Ritzberger 100 0.20
et al., 2010)
Glass fiber post (Sorrentino Ex = 37 νxy = 0.27 Gxy = 3.10
et al., 2007) Ey = 9.5 νxz = 0.34 Gxz = 3.50
Ez = 9.5 νyz = 0.27 Gyz = 3.10
a
Reported by the manufacturer.

Due to the nature of this finite element study with only one sample for
each group, a full statistical analysis was not required.

3. Results

In general, oblique loading generated much higher total deformation

and stresses compared to axial loading in all models. von Mises and total
deformation values are presented in Figs. 5 and 6 and Tables 3 and 4.
Starting with the restoration (crown or endocrown), in case of obli­
Fig. 3. Longitudinal section of the bone model showing the dimensions of the
que loading, models D and E with the 3 mm pulpal extension yielded von
trabecular and cortical bone. Mises values of 141.3 and 135.8 MPa, respectively. These values were
considerably lower than von Mises values of models B and C with the 5
mm axial extension (171.0 and 170.5 MPa respectively). While in case of
Table 1 axial loading, model B showed the lowest von Mises stress of 60.2 MPa,
The number of nodes and elements of all objects of the finite element model. followed by models D and E respectively, while model C exhibited the
Nodes Elements highest von Mises stresses (Figs. 5–7).
As for the stresses on the tooth structure under oblique loading,
Model A 283,626 189,090
Model B 285,777 191,852 model B showed the highest von Mises stress (39.7 MPa), while model C
Model C 285,975 191,546 showed the lowest von Mises stress (33.7 MPa). The induced von Mises
Model D 286,886 192,392 stresses and total deformations in models C and E with the axial
Model E 287,806 192,499 extension were 15% lower than those of models B and D with the butt
margin as shown in Figs. 5–8. For axial loading, model A with the
long axis of the tooth was applied to a set of 10 selected nodes on the conventional crown design showed the lowest von Mises stress of around
triangular ridge of the palatal cusp (Fig. 4B). For standardization, the 9.0 MPa, while model D showed the highest von Mises value of almost
number of selected nodes and their distribution were identical for all 14.0 MPa.
three models. A linear static analysis was performed and the total Finally, concerning the bone structure, model B exhibited the lowest
deformation and von Mises stress values were calculated for all models. von Mises stresses under both axial and oblique loading, while the total

3
M. Aldesoki et al. Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309

Fig. 4. Representation of the load cases showing the direction and points of nodal force application: (A) Axial load; (B) Oblique load.

Fig. 5. Comparison of peak von Mises stresses between the five models under axial and oblique loading.

Fig. 6. Comparison of maximum total deformations between the five models under axial and oblique loading.

Table 3 Table 4
Peak von Mises stress values at restoration, tooth structure and bone under axial Maximum total deformation values at restoration, tooth structure and bone
and oblique loads (MPa). under axial and oblique loads (μm).
Model Restoration Tooth Bone Model Restoration Tooth Bone

Axial Oblique Axial Oblique Axial Oblique Axial Oblique Axial Oblique Axial Oblique

A 90.9 138.1 9.2 38.7 9.9 31.3 A 6.1 40.0 5.3 30.3 4.0 19.9
B 60.2 171.0 10.6 39.7 9.3 30.5 B 5.8 38.5 5.3 30.7 4.0 19.7
C 118.2 170.5 12.1 33.7 10.8 33.7 C 6.2 38.0 5.3 28.8 4.1 19.5
D 99.7 141.3 13.9 38.4 11.1 33.8 D 6.2 38.3 5.7 30.5 4.1 19.5
E 96.6 135.8 12.8 32.8 10.3 33.5 E 6.2 48.0 5.4 30.0 4.1 19.7

4
M. Aldesoki et al.
Fig. 7. Von Mises stress distributions (MPa) in restoration, tooth structure, and bone under axial loading.
deformations were almost the same for all five models.
4. Discussion
Although endocrowns have proven to be a successful alternative to
conventional crowns (Papalexopoulos et al., 2021), some studies re­
ported that the clinical performance of premolars restored with endo­
crowns is worse than that of molars restored with endocrowns (Biacchi
and Basting, 2012; Bindl et al., 2006). This could be because the surface
available for adhesive cementation is larger in molars than in premolars,
and that the crown base/height ratio causes greater leverage in pre­
molars than in molars (Bindl et al., 2006). Thus, the basis of our study
was to investigate the biomechanical behavior (stress and strain distri­
butions) of endodontically treated maxillary premolars restored with
different endocrown designs.
One of the most important prerequisites for accurate and appropriate
5
Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
FEA is the creation of an accurate FE model, which in turn requires the
acquisition of a realistic geometry of the object under study. Therefore,
in the present work, a high-resolution CBCT was used for accurate
modeling. In addition, the professional and highly integrated medical
imaging software applications Mimics and 3-matic were used in accor­
dance with many FEA studies (Bouton et al., 2017; Celikten and Jacobs,
2017; Choi et al., 2013; Huang and Chen, 2013; Rodrigues et al., 2017).
Mimics is a professional medical imaging software that can be used to
create 3D surface and geometry models from stacks of 2D images
semi-automatically rather than manually.
To precisely simulate the clinical situation, cortical and trabecular
bone models were simulated as a bony cylinder with an outer shell of
cortical bone and a core of trabecular bone (El-Anwar et al., 2013). The
root of the tooth was then embedded in the bony cylinder within 2 mm
of its cementoenamel junction to mimic the position of the alveolar
bone, and the socket was generated by subtracting the root volume from
M. Aldesoki et al.
Fig. 8. Total deformation (mm) in restoration, tooth structure and bone under axial loading.
the cylinder using Boolean operations (Magne, 2007).
Since the focus of our study was on the stress distribution within the
tooth-restoration interface, the periodontal ligament (PDL) was not
simulated in our study, and for computational simplicity, a perfect
bonded interaction between tooth and bone was assumed, in line with
several studies (Sorrentino et al., 2007; Tribst et al., 2021). Even
considering several in vitro studies that reported insignificant differ­
ences between the groups with and without PDL (Marchionatti et al.,
2014; Nawafleh et al., 2020).The Boundary conditions were applied to
the models in Ansys software, and according to relevant studies (Liu
et al., 2014; Rodrigues et al., 2017), the base of the bony cylinder was
assumed to be fixed in the X, Y, and Z directions to prevent rigid body
displacement; this corresponds to physical conditions in which the
displacement of the rest of the structure is negligible.
Since premolars are subjected to more horizontally directed forces
than molars, which may affect the stress distribution (Skupien et al.,
2016), an oblique load was applied in addition to the axial load as two
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Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
separate load cases (Shams et al., 2022; Verri et al., 2016). In accordance
with the studies of C. Lin et al. (2011) and L. Sandu et al. (2012), the
applied load was 100 N, which corresponds to the average biting force in
the premolar region.
Generally speaking, the von Mises values for tooth structure in all
models were well below the yield strength of dentin (75 MPa) despite
the absence of PDL (Nalla et al., 2003). In addition, all von Mises stresses
exhibited on the ceramic material were far below its flexural strength
(300–420 MPa) (Ritzberger et al., 2010). Our correlation between the
resultant stresses and the yield and flexural strength of the tested ma­
terials is consistent with Wang et al. (2016), Duaibis et al. (2012) and
Shams et al. (2021) who reported that a fixed partial denture fractures
when the stresses induced in it exceed the flexural tensile strength or
yield strength of its materials.
These results indicate a promising success of the endocrown
approach for the restoration of endodontically treated premolars despite
previous evidence (Bindl et al., 2006), which supports the recent
M. Aldesoki et al.
systematic review by Thomas et al. (2020) who stated that endocrowns
for premolars are as reliable as endocrowns for molars, and goes well
with the studies of Lin et al. (2010) who indicated that the endocrown
and the conventional crown restorations for endodontically treated
premolars with mesio-occluso-distal (MOD) preparation had similar
longevity, and also with Forberger et al. (Forberger and Göhring, 2008)
who found that the fracture strength values for endocrowns and con­
ventional crowns with post were almost the same. However, our study
results do not agree with the findings of Bindl et al. (2006) who
concluded that the failure rate of endocrowns is higher in premolars
than in molars, and that ceramic endocrowns must be limited to
restoring endodontically treated molars to achieve satisfactory perfor­
mance in terms of bond strength and response to occlusal loads. This
discrepancy may be because Bindl’s study was a clinical study in which
premolars with badly mutilated clinical crowns were used for endo­
crown restorations, whereas the conventional crowns used had a die
height of at least 3 mm and a convergence angle of 6◦ ; however, in our
FEA, all models were standardized and designed with almost the same
residual tooth structure.
Several studies have reported different biomechanical behavior of
different endocrown designs in terms of change in pulpal extension
depth, use of a butt margin, or an axial extension (Aboel-Fadl and
El-Desoky, 2017; Gaintantzopoulou and El-Damanhoury, 2016; Hayes
et al., 2017; Raymond et al., n.d.); thus, comparison of different designs
was a major concern in our study. When we compared the butt margin
designs to the axial extension designs, we found that the induced von
Mises stresses on the tooth structure were 15% lower in models C and E
with the axial extension compared to models B and D with the butt
margin. From a biomechanical point of view, the better behavior of the
design with the axial extension could be due to the addition of short
axial walls, which counteracted the shear stresses through the walls and
caused a better load distribution through the margin, alleviating the
stress on the pulp floor which typically explains the significant reduction
of stresses on the tooth structure, especially in the oblique load case (Zhu
et al., 2017).
This agrees with the study by Raymond et al. (Raymond et al., n.d.)
which concluded that endocrowns fabricated on a preparation with a 2
mm deep pulp extension and a shoulder line of 1.5 mm can withstand
compressive loads exceeding the posterior masticatory forces. Also, the
results of the study by Taha et al. (2018) showed that in the restoration
of endodontically treated teeth, a short axial wall and a shoulder finish
line can increase its fracture resistance.
As for the resulting equivalent stresses on the endocrowns, models B
and D with the butt margin showed a considerable reduction in von
Mises stresses because the butt margin is made parallel to the occlusal
plane and forms a vertical stop that resists compressive stresses. Eval­
uation of the extension of the pulpal cavity on the stress distribution
showed that models D and E with a pulpal extension of 3 mm exerted
more stress on the endocrown ceramic material compared to models B
and C with a pulpal extension of 5 mm, especially under oblique loading.
This can be explained by the large occluso-gingival dimension of the
premolars together with their narrowed base, which may cause a
stronger leverage effect (Papalexopoulos et al., 2021), especially
because premolars receive more horizontally (non-axial) directed forces
than molars (Skupien et al., 2016). So, a reduction in the pulpal exten­
sion will thus shortens the lever arm and consequently reduces the
stresses in the endocrown. this result agrees with the study carried by
El-Damanhoury et al. (Gaintantzopoulou and El-Damanhoury, 2016)
who concluded that intra-radicular extension of the endocrown prepa­
ration negatively affected both the marginal adaptation and the internal
fit of the final restoration.
However, for axial loading, model B showed a drastic decrease in von
Mises stress compared to the other groups (only 60.2 MPa). This could
be attributed to the vertical stops obtained by the circumferential butt
joint and the increased pulpal extension of the endocrown, which
allowed a larger surface area for a better stress distribution of the axially
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Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
directed forces (Mörmann et al., 1998).
The published literature shows that endocrowns are a promising
restorative approach with an acceptable survival rate for endodontically
treated posterior teeth (Al-Dabbagh, 2021). We speculate that our re­
sults support this evidence by emphasizing the use of endocrowns as a
conservative restoration, especially for endodontically treated maxillary
premolars. Since the reduction of the pulp extension depth to 3 mm
improved the stress distribution, we recommend preserving the
remaining tooth structure as much as possible in line with the minimally
invasive treatment principle (Hayes et al., 2017).
One of the limitations of this study is the lack of the cement layer and
its representation by a bonded contact interaction, which could disre­
gard the different degree of bonding between the restoration and the
tooth structure. Another limitation of this study is that the models were
designed based on an extracted tooth with a simplified bone model. The
use of a realistic anatomical model segmented from a CBCT section of
the maxilla should be addressed in future work. Finally, further FEA
studies are recommended to investigate the biomechanical behavior of
different ceramic materials supported with a series of in vivo studies to
correlate the biomechanical results with the clinical behavior.
5. Conclusion
Within the limitations of this finite element study, we could conclude
that endocrowns are a conservative restorative approach for endodon­
tically treated maxillary premolars. Moreover, the reduction of the
pulpal extension depth to 3 mm with additional buccal and lingual axial
extensions improves the stress distribution within the tooth-restoration
interface.
CRediT authorship contribution statement
Mostafa Aldesoki: Writing – original draft, Visualization, Software,
Methodology, Formal analysis, Data curation, Conceptualization.
Christoph Bourauel: Writing – review & editing, Validation, Supervi­
sion. Tarek Morsi: Writing – review & editing, Supervision, Investiga­
tion, Data curation. Mohamed I. El-Anwar: Visualization, Software,
Resources, Formal analysis. Ahmad K. Aboelfadl: Writing – review &
editing, Visualization, Validation, Supervision, Methodology. Tarek M.
Elshazly: Writing – review & editing, Visualization, Software, Data
curation.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgements
N/A.
References
Aboel-Fadl, A.K., El-Desoky, M.A., 2017. Influence of endocrown pulpal extension on
stress distribution in endodontically treated maxillary premolars A three-
dimensional finite element analysis. Egypt. Dent. J. 63, 3895–3905. Https://Doi.
Org/10.21608/Edj.2017.76455.
Al-Dabbagh, R.A., 2021. Survival and success of endocrowns: a systematic review and
meta-analysis. J. Prosthet. Dent. https://doi.org/10.1016/j.prosdent.2020.01.011.
Asmussen, E., Peutzfeldt, A., Sahafi, A., 2005. Finite element analysis of stresses in
endodontically treated, dowel-restored teeth. J. Prosthet. Dent 94, 321–329. https://
doi.org/10.1016/j.prosdent.2005.07.003.
Assif, D., Gorfil, C., 1994. Biomechanical considerations in restoring endodontically
treated teeth. J. Prosthet. Dent 71, 565–567. https://doi.org/10.1016/0022-3913
(94)90438-3.
Biacchi, G.R., Basting, R.T., 2012. Comparison of fracture strength of endocrowns and
glass fiber post-retained conventional crowns. Operat. Dent. 37, 130–136. https://
doi.org/10.2341/11-105-L.
M. Aldesoki et al.
Bindl, A., Mörmann, W.H., 1999. Clinical evaluation of adhesively placed Cerec Endo-
Crowns after 2 years - preliminary results. J. Adhesive Dent. 1, 255–266. https://doi.
org/10.1007/s13398-014-0173-7.2.
Bindl, A., Richter, B., Mörmann, W.H., 2006. Survival of ceramic computer-aided design/
manufacturing crowns bonded to preparations with reduced macroretention
geometry. J. Prosthet. Dent 95, 81. https://doi.org/10.1016/j.
prosdent.2005.09.002.
Bouton, A., Simon, Y., Goussard, F., Teresi, L., Sansalone, V., 2017. New finite element
study protocol: clinical simulation of orthodontic tooth movement. Int. Orthod. 15,
165–179. https://doi.org/10.1016/j.ortho.2017.03.001.
Celikten, B., Jacobs, R., 2017. Assessment of volumetric distortion artifact in filled root
canals using different cone-beam computed tomographic devices. J. Endod. 1–5.
https://doi.org/10.1016/j.joen.2017.03.035.
Chang, C.Y., Kuo, J.S., Lin, Y.S., Chang, Y.H., 2009. Fracture resistance and failure modes
of CEREC endo-crowns and conventional post and core-supported CEREC crowns.
J. Dent. Sci. 4, 110–117. https://doi.org/10.1016/S1991-7902(09)60016-7.
Choi, D.S., Cha, B.K., Jang, I., Kang, K.H., Kim, S.C., 2013. Three-dimensional finite
element analysis of occlusal stress distribution in the human skull with premolar
extraction. Angle Orthod. 83, 204–211. https://doi.org/10.2319/020112-89.1.
Dejak, B., Młotkowski, A., Langot, C., 2012. Three-dimensional finite element analysis of
molars with thin-walled prosthetic crowns made of various materials. Dent. Mater.
28, 433–441. https://doi.org/10.1016/j.dental.2011.11.019.
Dietschi, D., Duc, O., Krejci, I., Sadan, A., 2008. Biomechanical considerations for the
restoration of endodontically treated teeth: a systematic review of the literature, Part
II (Evaluation of fatigue behavior, interfaces, and in vivo studies). Quintessence Int.
(Berl). 39, 117–129.
Duaibis, R., Kusnoto, B., Natarajan, R., Zhao, L., Evans, C., 2012. Factors affecting
stresses in cortical bone around miniscrew implants A three-dimensional finite
element study. Angle Orthod. 82, 875–880. https://doi.org/10.2319/111011-696.1.
El-Anwar, M.I., Fawzy, U.M., Mohamad, H.a., Tamam, R.a., Yousief, S.a., 2013. Effect of
different abutment materials of implant on stress distribution using three-
dimensional finite element analysis. Med. Res. J. 12, 115–123. https://doi.org/
10.1097/01.MJX.0000437958.81125.99.
El-Ma’aita, A., Al-Rabab’ah, M.A., Abu-Awwad, M., Hattar, S., Devlin, H., 2022.
Endocrowns clinical performance and patient satisfaction: a randomized clinical trial
of three monolithic ceramic restorations. J. Prosthodont. 31, 30–37. https://doi.org/
10.1111/jopr.13414.
Forberger, N., Göhring, T.N., 2008. Influence of the type of post and core on in vitro
marginal continuity, fracture resistance, and fracture mode of lithia disilicate-based
all-ceramic crowns. J. Prosthet. Dent 100, 264–273. https://doi.org/10.1016/
S0022-3913(08)60205-X.
Gaintantzopoulou, M.D., El-Damanhoury, H.M., 2016. Effect of preparation depth on the
marginal and internal adaptation of computer-Aided design/computerassisted
manufacture endocrowns. Operat. Dent. 41, 607–616. https://doi.org/10.2341/15-
146-L.
Govare, N., Contrepois, M., 2020. Endocrowns: a systematic review. J. Prosthet. Dent
123, 411–418. https://doi.org/10.1016/J.PROSDENT.2019.04.009 e9.
Guzy, G.E., Nicholls, J.I., 1979. In vitro comparison of intact endodontically treated teeth
with and without endo-post reinforcement. J. Prosthet. Dent 42, 39–44.
Hayes, A., Duvall, N., Wajdowicz, M., Roberts, H., 2017. Effect of endocrown pulp
chamber extension depth on molar fracture resistance. Operat. Dent. 42, 327–334.
https://doi.org/10.2341/16-097-L.
Hirschfeld, Z., Stern, N., 1972. Post and core—the biomechanical aspect. Aust. Dent. J.
17, 467–468. https://doi.org/10.1111/j.1834-7819.1972.tb04979.x.
Huang, T.J., Schilder, H., Nathanson, D., 1992. Effects of moisture content and
endodontic treatment on some mechanical properties of human dentin. J. Endod. 18,
209–215. https://doi.org/10.1016/S0099-2399(06)81262-8. S0099-2399(06)
81262-8 [pii]\r.
Huang, Z., Chen, Z., 2013. Three-dimensional finite element modeling of a maxillary
premolar tooth based on the micro-CT scanning: a detailed description. J. Huazhong
Univ. Sci. Technol. - Med. Sci. 33, 775–779. https://doi.org/10.1007/s11596-013-
1196-6.
Lin, C.L., Chang, Y.H., Chang, C.Y., Pai, C.A., Huang, S.F., 2010. Finite element and
Weibull analyses to estimate failure risks in the ceramic endocrown and classical
crown for endodontically treated maxillary premolar. Eur. J. Oral Sci. 118, 87–93.
https://doi.org/10.1111/j.1600-0722.2009.00704.x.
Lin, C.L., Chang, Y.H., Pai, C.A., 2011. Evaluation of failure risks in ceramic restorations
for endodontically treated premolar with MOD preparation. Dent. Mater. 27,
431–438. https://doi.org/10.1016/j.dental.2010.10.026.
Liu, S., Liu, Y., Xu, J., Rong, Q., Pan, S., 2014. Influence of occlusal contact and cusp
inclination on the biomechanical character of a maxillary premolar: a finite element
analysis. J. Prosthet. Dent 112, 1238–1245. https://doi.org/10.1016/j.
prosdent.2014.04.011.
Ma, P.S., Nicholls, J.I., Junge, T., Phillips, K.M., 2009. Load fatigue of teeth with
different ferrule lengths, restored with fiber posts, composite resin cores, and all-
ceramic crowns. J. Prosthet. Dent 102, 229–234. https://doi.org/10.1016/S0022-
3913(09)60159-1.
Magne, P., 2007. Efficient 3D finite element analysis of dental restorative procedures
using micro-CT data. Dent. Mater. 23, 539–548. https://doi.org/10.1016/j.
dental.2006.03.013.
Marchionatti, A.M.E., Wandscher, V.F., Broch, J., Bergoli, C.D., Maier, J., Valandro, L.F.,
Kaizer, O.B., 2014. Influence of periodontal ligament simulation on bond strength
and fracture resistance of roots restored with fiber posts. J. Appl. Oral Sci. 22,
450–458. https://doi.org/10.1590/1678-775720140067.
McLean, A., 1998. Predictably restoring endodontically treated teeth. J. Can. Dent.
Assoc.
8
Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
Mörmann, W.H., Bindl, a, Lüthy, H., Rathke, a, 1998. Effects of preparation and luting
system on all-ceramic computer-generated crowns. Int. J. Prosthodont. (IJP) 11,
333–339.
Nalla, R.K., Kinney, J.H., Ritchie, R.O., 2003. On the fracture of human dentin: is it
stress- or strain-controlled? J. Biomed. Mater. Res. 67, 484–495. https://doi.org/
10.1002/jbm.a.10079.
Nawafleh, N., Bibars, A.R., Elshiyab, S., Janzeer, Y., 2020. In vitro simulation of
periodontal ligament in fatigue testing of dental crowns. Eur. J. Dermatol. 14,
380–385. https://doi.org/10.1055/s-0040-1713953.
Nelson, S.J., Ash, M.M., 2010. Cusp, fossa, and marginal ridge relations. In: Wheeler’s
Dental Anatomy, Physiology, and Occlusion. Elsevier Inc, pp. 288–291.
Otto, T., 2004. Computer-aided direct all-ceramic crowns: preliminary 1-year results of a
prospective clinical study. Int. J. Periodontics Restor. Dent.
Papa, J., Cain, C., Messer, H.H., 1994. Moisture content of vital vs endodontically treated
teeth. Dent. Traumatol. 10, 91–93. https://doi.org/10.1111/j.1600-9657.1994.
tb00067.x.
Papalexopoulos, D., Samartzi, T.K., Sarafianou, A., 2021. A thorough analysis of the
endocrown restoration: a literature review. J. Contemp. Dent. Pract. 22, 422–426.
https://doi.org/10.5005/jp-journals-10024-3075.
Pissis, P., 1995. Fabrication of a metal-free ceramic restoration utilizing the monobloc
technique. Pract. Periodontics Aesthet. Dent. 7, 83–94. https://doi.org/10.1055/s-
2004-815600.
Ramos Verri, F., Santiago Junior, J.F., de Faria Almeida, D.A., de Oliveira, G.B.B., de
Souza Batista, V.E., Marques Honório, H., Yoshito Noritomi, P., Piza Pellizzer, E.,
2015. Biomechanical influence of crown-to-implant ratio on stress distribution over
internal hexagon short implant: 3-D finite element analysis with statistical test.
J. Biomech. 48, 138–145. https://doi.org/10.1016/j.jbiomech.2014.10.021.
Raymond, C., Payant, L., Laval, U., n.d. In vitro fracture strength evaluation of ceramic
endo-crowns with an in-Ceram Core 10.
Reeh, E.S., Messer, H.H., Douglas, W.H., 1989. Reduction in tooth stiffness as a result of
endodontic and restorative procedures. J. Endod. 15, 512–516. https://doi.org/
10.1016/S0099-2399(89)80191-8.
Ritzberger, C., Apel, E., Höland, W., Peschke, A., Rheinberger, V.M., 2010. Properties
and clinical application of three types of dental glass-ceramics and ceramics for CAD-
CAM technologies. Materials 3, 3700–3713. https://doi.org/10.3390/ma3063700.
Rodrigues, M. de P., Soares, P.B.F., Valdivia, A.D.C.M., Pessoa, R.S., Veríssimo, C.,
Versluis, A., Soares, C.J., 2017. Patient-specific finite element analysis of fiber post
and ferrule design. J. Endod. 43, 1539–1544. https://doi.org/10.1016/j.
joen.2017.04.024.
Sandu, L., Topală, F., Porojan, S., 2012. Finite element study on corono-radicular
restored premolars. Int. J. Model. Optim. 2, 716–719.
Schwartz, R.S., Robbins, J.W., 2004. Post placement and restoration of endodontically
treated teeth: a literature review. J. Endod. 30, 289–301. https://doi.org/10.1097/
00004770-200405000-00001.
Shams, A., Elsherbini, M., Elsherbiny, A.A., Özcan, M., Sakrana, A.A., 2022.
Rehabilitation of severely-destructed endodontically treated premolar teeth with
novel endocrown system: biomechanical behavior assessment through 3D finite
element and in vitro analyses. J. Mech. Behav. Biomed. Mater. 126, 105031 https://
doi.org/10.1016/J.JMBBM.2021.105031.
Shams, A., Sakrana, A.A., Abo El-Farag, S.A., Elerian, F.A., Özcan, M., 2021.
Biomechanical behavior of endodontically treated premolar teeth restored with
novel endocrown system: 3D Finite Element and Weibull analyses. J. Mech. Behav.
Biomed. Mater. 124 https://doi.org/10.1016/j.jmbbm.2021.104853.
Skupien, J.A., Luz, M.S., Pereira-Cenci, T., 2016. Ferrule effect. JDR Clin. Transl. Res. 1,
31–39. https://doi.org/10.1177/2380084416636606.
Soares, C.J., Santana, F.R., Silva, N.R., Preira, J.C., Pereira, C.A., 2007. Influence of the
endodontic treatment on mechanical properties of root dentin. J. Endod. 33,
603–606. https://doi.org/10.1016/j.joen.2007.01.016.
Sorrentino, R., Aversa, R., Ferro, V., Auriemma, T., Zarone, F., Ferrari, M., Apicella, A.,
2007. Three-dimensional finite element analysis of strain and stress distributions in
endodontically treated maxillary central incisors restored with diferent post, core
and crown materials. Dent. Mater. 23, 983–993. https://doi.org/10.1016/j.
dental.2006.08.006.
Stern, N., Hirshfeld, Z., 1973. Principles of preparing endodontically treated teeth for
dowel and core restorations. J. Prosthet. Dent 30, 162–165. https://doi.org/
10.1016/0022-3913(73)90051-6.
Taha, D., Spintzyk, S., Schille, C., Sabet, A., Wahsh, M., Salah, T., Geis-Gerstorfer, J.,
2018. Fracture resistance and failure modes of polymer infiltrated ceramic
endocrown restorations with variations in margin design and occlusal thickness.
J. Prosthodont. Res. 62, 293–297. https://doi.org/10.1016/j.jpor.2017.11.003.
Thomas, R.M., Kelly, A., Tagiyeva, N., Kanagasingam, S., 2020. Comparing endocrown
restorations on permanent molars and premolars: a systematic review and meta-
analysis. Br. Dent. J. 1–9. https://doi.org/10.1038/s41415-020-2279-y.
Tribst, J.P.M., Borges, A.L.S., Silva-Concílio, L.R., Bottino, M.A., Özcan, M., 2021. Effect
of restorative material on mechanical response of provisional endocrowns: a
3D—FEA study. Materials. https://doi.org/10.3390/ma14030649.
Verri, F.R., Cruz, R.S., de Souza Batista, V.E., Almeida, D.A. de F., Verri, A.C.G.,
Lemos, C.A. de A., Santiago Júnior, J.F., Pellizzer, E.P., 2016. Can the modeling for
simplification of a dental implant surface affect the accuracy of 3D finite element
analysis? Comput. Methods Biomech. Biomed. Eng. 19, 1665–1672. https://doi.org/
10.1080/10255842.2016.1176156.
Wang, G., Zhang, S., Bian, C., Kong, H., 2016. Verification of finite element analysis of
fixed partial denture with in vitro electronic strain measurement. J. Prosthodont.
Res. 60, 29–35. https://doi.org/10.1016/j.jpor.2015.08.003.
M. Aldesoki et al.
Zamin, C., Silva-Sousa, Y.T.C., Souza-Gabriel, A.E., Messias, D.F., Sousa-Neto, M.D.,
2012. Fracture susceptibility of endodontically treated teeth. Dent. Traumatol. 28,
282–286. https://doi.org/10.1111/j.1600-9657.2011.01087.x.
Zarow, M., Devoto, W., Saracinelli, M., 2009. Reconstruction of endodontically treated
posterior teeth–with or without post? Guidelines for the dental practitioner. Eur. J.
Esthetic Dent. 4, 312–327.
Journal of the Mechanical Behavior of Biomedical Materials 133 (2022) 105309
Zhu, J., Rong, Q., Wang, X., Gao, X., 2017. Influence of remaining tooth structure and
restorative material type on stress distribution in endodontically treated maxillary
premolars: a finite element analysis. J. Prosthet. Dent 117, 646–655. https://doi.
org/10.1016/j.prosdent.2016.08.023.