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Fracture Resistance of Three Post and Core Systems in Endodontically Treated

Teeth Restored with All-ceramic Crowns

Article in Hydrometallurgy · January 2012

DOI: 10.1016/j.ksujds.2011.10.001

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King Saud University Journal of Dental Sciences (2012) 3, 33–38

King Saud University

King Saud University Journal of Dental Sciences

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ORIGINAL ARTICLE

Fracture resistance of three post and core systems

in endodontically treated teeth restored with all-ceramic
crowns
Tariq Abduljabbar a,*, Haneef Sherfudhin a, S.A. AlSaleh a,
Abdulaziz A. Al-Helal b, Saleh S. Al-Orini b, Naif A. Al-Aql b

a
Department of Prosthetic Dental Sciences, College of dentistry, King Saud University, Saudi Arabia
b
College of Dentistry, King Saud University, Saudi Arabia

Received 26 June 2011; accepted 5 October 2011

Available online 27 November 2011

KEYWORDS Abstract The restoration of endodontically treated teeth requires the fabrication of a post and
Fracture resistance; core to provide retention and support for the final crowns. The objective of this study was to com-
Post and core; pare the fracture resistance of endodontically treated teeth restored with glass fiber post and com-
Endodontically; posite resin cores, customized zirconia posts, and cast metal post and cores. A total of 40 human
Teeth; extracted mandibular first premolars were used for the study. The teeth were randomly divided into
All-ceramic; four groups. Group A represented a control group that did not receive any posts and was filled with
Crowns core material only; Group B comprised cast metal posts and cores; Group C comprised custom
milled zirconia posts and cores; and Group D comprised glass fiber posts. All groups were prepared
to receive all ceramic crowns. All samples were subjected to compressive testing with an Instron
machine (Universal Testing Machine) and fracture loads and failure patterns were analyzed. The
findings indicated a statistically significant difference between the failure loads in the groups stud-
ied. The mean load required to fracture the zirconia custom posts was higher (765.1 ± 48.5 N) than
the fiber posts and the cast posts and cores (P < 0.001). The fiber posts resisted a mean load of

* Corresponding author. Address: Prosthetic Dental Sciences,

College of Dentistry, King Saud University, P.O. Box 60169, Riyadh
11545, Saudi Arabia. Tel.: +966 1 467 7325, mobile: +966 504413113;
fax: +966 1 465 6663.
E-mail address: tajabbar@yahoo.com (T. Abduljabbar).

2210-8157 ª 2011 King Saud University. Production and hosting by

Elsevier B.V. All rights reserved.

Peer review under responsibility of King Saud University.

doi:10.1016/j.ksujds.2011.10.001

Production and hosting by Elsevier

34
561.4 ± 37.2 N which was higher than the cast posts and cores. The control group revealed the low-
est value of fracture resistance. Within the limitations of this study, it can be concluded that cus-
tomized zirconia posts and cores resisted a higher mean load (765.1 + 48.5) when compared
with other post and core systems. Failure patterns within this group revealed catastrophic failure,
but the failure loads were much higher than the average occlusal load.
ª 2011 King Saud University. Production and hosting by Elsevier B.V. All rights reserved.
1. Introduction
Endodontically treated teeth with insufficient tooth structure
are often restored with crowns (Carter et al., 1983; Sorensen
and Martinoff, 1984). In teeth with substantial hard tissue loss
resulting from cavities or trauma, posts are often necessary for
providing sufficient retention for the core material (Peroz et
al., 2005). Although posts have been recommended to
strengthen the teeth, several investigators have cautioned that
posts with inadequate resistance to rotational forces can weak-
en the teeth (Zhi-Yue and Yu-Xing, 2003).
The fracture susceptibility of teeth restored with posts may
be related to factors such as the amount of remaining tooth
structure, which provides resistance to the fracture of the tooth
(Ng et al., 2006), as well as the characteristics of the post, such
as the material composition, modulus of elasticity, diameter,
and length (Fokkinga et al., 2006). A Root fracture is the most
serious type of failure in post-restored teeth (Testori et al.,
1993; Wu et al., 2004). To avoid root fractures, a post having
a modulus of elasticity similar to that of dentin helps in distrib-
uting the stress of occlusal load in a uniform pattern (Akkayan
and Gülmez, 2002).
The cast gold post and core has been regarded as the ‘‘gold
standard’’ in post-and-core restorations because of its superior
success rate (Bergman and Lundquist, 1989; Creugers et al.,
1993). Alternatives to cast metal posts and cores have been
developed. The use of prefabricated posts and custom-made
buildups with amalgam or composite resin has simplified the
restorative procedure because all steps can be completed chair-
side with acceptable clinical success (Linde, 1984). The choice
of an appropriate restoration for endodontically treated teeth
is guided by strength and esthetics. The restoration of teeth
with adhesively cemented internal restorations offers improved
mechanical stability over cemented restorations (Trope and
Tronstad, 1991).
The development of tooth colored posts has improved the
esthetics of teeth restored with posts and cores (Sidoli et al.,
1997; Mannocci et al., 1999; Rosentritt et al., 2000). Zirconium
dioxide and glass fiber-reinforced composite resins (FRC), in
particular, are the foundation of many modern post-and-core
concepts (Qing et al., 2007). Several studies have investigated
the fracture resistance of fiber posts since their introduction
and compared it with that of the metal posts. Unfortunately,
the results have not been consistent, with some authors report-
ing that endodontically treated teeth restored with fiber posts
showed lower fracture resistance than that of teeth restored
with metal posts (Martinez-Insua et al., 1998; Newman et al.,
2003). Other authors, however, indicated the fracture resis-
tance of fiber post–restored teeth to be equal to or greater than
that of teeth restored with metal posts (Rosentritt et al., 2000;
Raygot et al., 2001). Zirconia posts were first introduced by
Meyenberg et al. (1995) who reported that the flexural
T. Abduljabbar et al.
strengths (900 1200 MPa) of these posts was comparable to
that of cast gold or titanium, and that it is possible to have
the same post dimensions as high gold alloys or titanium. Zir-
conia is a widely used material because of its good chemical
stability, high mechanical strength, high toughness, and a
Young’s modulus similar to that of stainless steel alloy (Piconi
and Maccauro, 1999). Apart from its favorable chemical and
physical properties, it has the esthetic advantage of having a
color similar to that of natural teeth (Ahmad, 1998; Vichi et
al., 2000). The high elastic modulus of elasticity of zirconia
posts at 200 GPa (Guazzato et al., 2004) causes stress to be
transferred to the less rigid dentin, thereby resulting in root
fractures (Bateman et al., 2003). However, there is little con-
sensus with regard to their mechanical behavior and reliability
and other factors which would contribute to their optimal per-
formance. Therefore the objective of the study was to compare
the fracture resistance of endodontically treated teeth prepared
with a 2 mm ferrule restored with a cast post and core, a glass
fiber post with a composite resin core, and a customized zirco-
nia post restored with an all-ceramic crown.
2. Materials and methods
2.1. Specimen preparation
A total of 40 sound, single-rooted mandibular first premolars
with similar size and shape were collected. Root lengths were
measured from apex to tip of the cusps, together with the buc-
colingual and mesiodistal dimensions at the highest bulge with
a digital caliper (Schnelltaster, Dentaurum, Germany). The
specimens were stored in a solution of 0.9% saline at room
temperature. Selection criteria also included the absence of
root caries, restorations, or previous endodontic treatment.
The teeth were divided into 4 groups of 10 specimens each.
All teeth underwent root canal treatment. The root canals were
instrumented manually in a step-back technique to an apical
size of ISO 40. The canals were dried with absorbent paper
points and obturated with gutta-percha (Roeko, Langenau,
Germany) and sealer (AH plus, Dentsply DeTrey, Konstanz,
Germany) with cold lateral condensation. After endodontic
treatment, each root was thinly covered with a silicone impres-
sion material to simulate the thickness of the periodontal liga-
ment ( Imprint II Garant light-body by 3M ESPE). All teeth
were embedded in an acrylic resin cube (RAPID REPAIR,
Dentsply, Germany). The acrylic resin blocks were shaped to
fit into a retentive device for fracture testing (Fig. 1).
2.2. Post space preparation
Post space preparation for all teeth was initiated after 7 days
from obturation by the use of a universal starter drill at a
Fracture resistance of three post and core systems 35

37 percent phosphoric acid gel (Total Etch). The surface was

rinsed with water and dried with paper points. The bonding
agent EXCITE F (Ivoclar, vivadent) was applied and the mul-
ticore material was injected into the etched chambers. The core
was then built with the same material to the desired dimensions.

2.3.2. Glass fiber post group

The glass fiber posts (RelyX, Fiber 3 M ESPE) were cemented
and the core was built up with MULTICORE FLOW system
(Ivoclar Vivadent). The dentin was etched for 15 seconds with
37% phosphoric acid gel (Total Etch). The surface was rinsed
with water and dried with paper points. The bonding agent
EXCITE F (Ivoclar, Vivadent) was applied and the multicore
material was injected into the etched roots. Each post was
placed to its full depth, and the core was contoured to the de-
sired dimensions.

2.3.3. Cast post and core

Figure 1 Line diagram showing tooth preparation and embed-
ding in acrylic resin for testing in Instron machine.
speed of 5000 rpm to a depth of 9 mm for the post space. The
post space for all the groups was prepared with Gates Glidden
size 1 up to size 4 (1.1 mm) (and size 5 to enlarge the canal ori-
fice), keeping 4 to 5 mm as an apical seal (Fig. 1).
Cast posts and cores were fabricated with Duralay (Reliance
Dental Manufacturing, Worth, IL). Plastic Para-post systems
were covered with Duralay, and an impression of the canal
was made. The core was also built with the same material.
All of the specimens were then prepared to final premeasured
dimensions. Posts and cores were invested in Beauty-Cast
(Whip Mix Corp., Louisville, KY) without a ring liner. After
casting, each post and core was tried to verify the fit and
cemented with zinc phosphate cement (Mizzy Inc., Cherry
Hill, NJ).

2.2.1. Teeth preparation before post cementation
All teeth were prepared to receive an all-ceramic crown with a
finish line of 0.5 mm above the CEJ. The axial reduction was
done with an MRD gauged diamond (Lot-NR 1599, DFS
Dental and Technical Products, GmbH, Germany) which
was attached to the milling machine (K9 Milling Apparatus-
990, Kavo, Germany) for every group. The MRD gauged
diamond had a self-limiting tip, which produced a 1 mm deep
chamfer, and the margins and the angle of convergence were
standardized. Each tooth after preparation had dentin support
of 2 mm. The buccolingual and mesiodistal widths were mea-
sured with the calibrated gauge caliper to be approximately
in the same range (Table 1). The ferrule used in this study
was 2.0 mm. The occlusal surface of the prepared teeth was
flattened to ensure the accurate fit of the posts.
2.3. Post and core fabrication
2.3.1. The control group
The gutta-percha was removed from the pulp chambers to 3-
4 mm in depth. The dentine was etched for 15 seconds with
2.3.4. Zirconia post and core group
The same technique for fabricating the cast post and core was
used, except that the Duralay buildup of the post and cores
was scanned and the presintered Y-TZP Cercon Base blanks
were milled with the Cercon brain unit (DeguDent, Hanau,
Germany) according to the manufacturer’s instructions. The
Zirconia posts were cemented with glass ionomer cement
GIC (GC Fuji I by GCAmerica) and seated for 7 min with
finger pressure.
2.4. Restorative procedures
1. Group A (Control). No post was placed. Only the core
material was placed and served as the control group for
comparison of the results.
2. Group B (Cast Post and Core).
3. Group C (Fiber post).
4. Group D (Customized zirconium post)
2.5. Crown fabrication

Table 1 Dimension of prepared tooth. After post and core cementation and finalization of the tooth
Buccolingual Mesiodistal preparation, the distance from the finish line to the occlusal
surface of the preparation was 4 mm. Each tooth preparation
Mean Range Mean Range
from all the groups was measured with a digital caliper to en-
(mm) (mm) (mm) (mm)
sure similar dimensions both mesiodistally and buccolingually.
Control group (A) 3.38 3–3.7 5.2 5–5.4 Final impressions were made for all the specimen with a poly-
Cast post-core (B) 4.3 3.7–4.81 5.46 4.75–5.87
vinylsiloxane impression material (Elite by Zhermack),and the
Glass fiber post (C) 3.34 3.2–3.54 4.8 4.34–5.3
master die was fabricated with die Stone (Heraeus Kulzer, Ha-
Zircon (D) 3.2 3.00–3.60 5.16 5-5.25
nau, Germany).
36 T. Abduljabbar et al.

Zirconia copings were made by scanning the master die. The

presintered Y-TZP Cercon base blanks were milled with the
Cercon brain unit (DeguDent, Hanau, Germany) according
to the manufacturer’s instructions. All the copings were steam
cleaned, and porcelain veneering was done and measurements
were made after ceramic application to maintain the same
thickness of ceramic for all the specimens.
The crowns were cleaned with ethanol, dried, and cemented
with glass ionomer cement (GC Fuji I by GC America). The
restorations were kept on the prepared samples under finger
pressure for 30s, and excess cement was removed with a sharp
instrument after 10 min. After the cementation procedures, the
samples were again maintained in a wet condition. Calibration
for each step and procedure in this study was done by the same
examiner for each specimen.

2.6. Fracture strength test

The specimens were tested with a universal testing machine

(Instron 8500 Plus, 100 Royal St. Canton, USA), set to deli-
ver an increasing load until fracture. The specimens were
placed at an angle of 45 degree to the long axis of the tooth, Figure 3 Photograph showing orientation of sample in Instron
with the application point midway between the lingual slope machine.
of the buccal cusp, and between the central fissure and the
cusp tip (Figs. 2 and 3). The crosshead speed of 0.01 cm/
min was used, and the load was applied at an angle of 45 Table 2 Failure pattern of study group.
degrees to the long axis of the tooth. The force applied was
Noncatastrophic Catastrophic failure Group (N = 10)
recorded in newtons. After loading, the mode of failure was failure (restorable) (nonrestorable)
recorded for each specimen and classified as either a favor-
able fracture above the cementoenamel junction (repairable) 10 0 A – Control Group
1 9 B – Cast Post and Core
or a catastrophic fracture of the root below the cemento-
7 3 C – Glass Fiber Post
enamel junction (nonrepairable) (Table 2). These inspections 1 9 D – Zirconium Post
were made with a stereomicroscope (Stereoscopic zoom
microscope, SMZ-1000, Nikon, Japan).
2.7. Statistical analysis

The fracture resistance (maximum load-to-failure) after load-

ing was compared among the 3 post types with a 1-way anal-
ysis of variance (ANOVA). Comparisons among the pairs were
performed with a Student-Newman-Keuls Multiple Compari-
sons Test exhibiting a P-value of <0.05, which was significant.

3. Results

3.1. Fracture strength test

The mean and standard deviations for failure loads were shown
in Fig. 4. A statistically significant difference was observed
among the failure loads in the groups studied. The load required
to fracture the zirconia custom post was higher (765.1 ± 48.5 N)
than the fiber post and cast post and core (P < 0.001). The fiber
post resisted a load of 561.4 ± 37.2 N, which was higher than
the cast post and core (Fig. 4). However, the values were not
statistically significant within these 2 groups.

4. Discussion

The task of restoring endodontically treated teeth is encoun-

Figure 2 Illustration showing test specimen orientation in tered almost daily in prosthodontic practice. Leempoel et al.
Instron machine. (1987) evaluated a large sample of teeth with single crown
Fracture resistance of three post and core systems
Figure 4 The mean fracture load among four groups studied.
restorations and found that 39% were nonvital and had re-
ceived some type of post restoration. In an effort to improve
the fracture resistance of endodontically treated teeth restored
with a post-and-core system, research has focused on post
materials, post designs, luting agents, and ferrule effect (Men-
doza et al., 1997; Martinez-Insua et al., 1998; Akkayan, 2004).
In the current study, all specimens were restored and tested
with complete-coverage of crowns to ensure standardization.
The placement of a crown during endodontic restoration testing
has been questioned, as this practice may obscure the effects of
different buildup techniques (Sorensen and Engelman, 1990;
Libman and Nicholls, 1995). It is true that a crown creates a
ferrule effect and variation in the load distribution when placed
over a core buildup if the margins encircle a sound dentin collar
(Butz et al., 2001). However, testing post and core preparations
without placement of a crown would not have reflected clinical
practice.
The current study attempted to compare the conventional
metal post and core with fiber post and custom-milled zirconia
posts. It has been reported that more rigid reconstructions are
unable to absorb stress and are therefore susceptible to failure
(Sidoli et al., 1997; Mannocci et al., 1999). The observations in
the present study may be attributed to the fact that zirconia
posts had the highest modulus of elasticity among the post
types tested. Higher modulus of elasticity results in less bend-
ing of the post/core unit under load; consequently, less stress is
exerted on the tooth (Butz et al., 2001). The failure pattern be-
tween the custom milled zirconia post and the conventional
cast post and core were similar (Table 2) and were classified
as a nonrestorable fracture, which may be attributed to the
rigidity of the post.
Available prefabricated fiber posts may be too wide for
some canals, especially mandibular incisors, and may exhibit
37
poor adaption to noncircular canals. Their use is limited when
there is insufficient coronal tooth structure (ferrule less than
2 mm) because of their lower modulus of elasticity, and they
may undergo flexure under functional stress and produce
micromovement at the core, producing decementation of the
crown (Ng et al., 2006). The fracture resistance of this group
was comparable with that of the custom cast post and core
(Fig. 2). With regard to the failure pattern, the fiber post group
exhibited more favorable fracture patterns (restorable) above
the cementoenamel junction than the cast post and core group
(Table 2).
Fracture strength values from other studies were not com-
parable with the results of the present study because of differ-
ences in research design. Moreover, in the present study, the
zirconia posts were custom milled unlike other studies which
used prefabricated zirconia posts (Sorensen and Engelman,
1990; Butz et al., 2001). The results of this study suggest that
custom milled zirconia posts and cores can be used when
esthetics are important, and when the anatomy of the root ca-
nal combined with the extensive loss of coronal tooth structure
requires the use of a custom post.
5. Conclusions
1. All 3 post and core systems performed favorably under
compressive testing.
2. The load required to fracture the zirconia custom post was
higher compared to the fiber post and cast post and core.
3. The fiber post resisted a load higher than the cast post and
core.
4. The fracture patterns of the teeth restored with fiber posts
were favorable (70%).
5. Multiple cracks were seen with the zirconia post group
within the root body (90% nonrestorable).
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