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JOURNAL OF ENDODONTICS
Copyright © 1992 by The American Association of Endodontists
Are Endodontically Treated Teeth more Brittle?
Christine M. Sedgley, BDS, MDSc, FRACDS, and Harold H. Messer, MDSc, PhD
This study compared biomechanical properties
(punch shear strength, toughness, hardness, and
load to fracture) of 23 endodontically treated teeth
(mean time since endodontic treatment: 10.1 yr) and
their contralateral vital pairs. Analyses using paired
t tests revealed no significant differences in punch
shear strength, toughness, and load to fracture be-
tween the two groups. Vital dentin was 3.5% harder
than dentin from contralateral endodontically
treated teeth (p = 0.002). The similarity between the
biomechanical properties of endodontically treated
teeth and their contralateral vital pairs indicates that
teeth do not become more brittle following endodon-
tic treatment. Other factors may be more critical to
failure of endodontically treated teeth.
The endodontic and prosthodontic literature contains re-
peated references to the widely held clinical perception that
endodontic treatment weakens teeth, resulting in increased
brittleness (i-4). While Rosen (1) described the dentin of
endodontically treated teeth as "desiccated and inelastic,"
Johnson et at. (2) additionally speculated that the elasticity of
dentin decreased with time following endodontic treatment.
Alternatively, it has been suggested that, rather than endodon-
tic treatment, loss of tooth structure associated with restora-
tive procedures was the major factor in weakening teeth.
Recently, it was shown that endodontic procedures reduced
the relative cuspal stiffness of premolar teeth by only 5%, in
contrast to an occlusal cavity preparation (20%) and an MOD
cavity preparation (63%) (5).
The purported brittleness of endodontically treated teeth
has been attributed to decreased moisture content. The sup-
porting evidence for this is primarily a study by Heifer et al.
(6) which showed a 9% lower moisture content of pulpless
versus vital dog teeth. Very few studies have actually com-
pared physical properties of endodontically treated versus vital
teeth. Stanford et al. (7) found no significant differences in
certain properties of dentin (modulus of elasticity, propor-
tional limit, and strength) from three pairs of patient-matched
vital and pulpless incisors. However, details of previous en-
dodontic treatment were not provided. Carter et al. (8) re-
ported that the dentin of endodontically treated teeth had a
14% lower punch shear strength and toughness than vital
teeth. This was based upon a comparison between 21 freshly
332
Printed in U.S.A.
VOL. 18, NO. 7, JULY 1992
extracted vital teeth and 6 teeth endodontically treated at least
1 yr previously. These conclusions should perhaps be viewed
with caution, as Smith and Cooper (9) reported a 3-fold range
in punch shear strength of dentin within a single tooth de-
pending on site of sampling. In contrast to the study of Carter
et al. (8), it has recently been suggested that the compressive
and tensile strengths of dentin from pulpless teeth are not
significantly different from those of normal dentin (10). Also,
Lewinstein and Grajower (11) found no difference in the
Vickers microhardness of dentin of 16 extracted vital teeth
and 32 teeth extracted at various intervals after endodontic
treatment (0.2 to 10 yr). Furthermore, recent research indi-
cated that no statistically significant differences existed in the
collagen cross-link content of dentin of age- and site-matched
root-filled and normal teeth (12).
Substantiated studies showing a reduction in elasticity and
an increase in brittleness in dentin of endodonticaUy treated
teeth are thus sparse, leaving relevant clinical questions un-
answered. This study was planned to answer the question of
whet~er loss of pulp vitality results in changes in tooth struc-
ture" Biomechanical properties (punch shear strength, tough-
ness, load to fracture, and microhardness) of the dentin of
extracted teeth with a known history of endodontic treatment
were compared with those of the contralateral vital tooth from
the same patient. In addition, because the effects of time after
extraction may produce inconsistent data (13), matched-pair
vital teeth were used to compare punch shear strength, tough-
ness, and load to fracture measurements obtained immedi-
ately following extraction and 3 months later.
MATERIALS AND METHODS
Biomechanical Properties of Endodontically Treated versus
Vital Teeth
SELECTION OF TEETH
Teeth were obtained from the Casualty and Oral Surgery
Departments of the Royal Dental Hospital of Melbourne and
affiliated hospitals. Ethics approval was obtained from the
Human Ethics Committee. Twenty-three matched pair teeth
with relatively large, regularly shaped straight roots were
selected following clinical and radiographic examination of
patients scheduled for multiple extractions for prosthetic rea-
sons. One tooth of each pair had a history of endodontic
 Vol. 18, No. 7, July 1992 Brittleness of Teeth 333

treatment, and vitality of the contralateral tooth was con-

i••
firmed by thermal testing or by examining the tooth for the
presence of pulp tissue when the tooth was sectioned. Those
teeth excluded had a history of periapical surgery, extensive
periodontal disease, and endodontic treatment performed less
than 1 yr previously. A history of patient age and sex, and
time since endodontic treatment was recorded. Each pair was
extracted by the same operator at the same appointment. 8 mm
Following extraction, teeth were stored in sterile-buffered
saline plus 0.05% sodium azide. During subsequent prepara-
tion and testing phases of the experiment, care was taken to
prevent dehydration. Seventeen of the matched pairs were
prepared and tested for punch shear strength, toughness, and
load to fracture immediately after extraction (within 3 to 5 FtG 1. Diagrammatic representation of preparation of root segment
h). One pair was tested 3 days after extraction, two pairs 2 for load to fracture testing. The tooth was mounted vertically in 3-
months after extraction, and three pairs 3 months after ex- mm of cold-cure acrylic resin and the crown and two cervical slices
traction. Microhardness testing was performed within 5 days (for punch shear strength, toughness, and microhardness testing)
of the other tests. All testing was done at room temperature. were removed. A 1-mm-deep seat was then cut in the coronal opening
of the 8-ram root segment (R) for seating of the loading device (L).
Using a constant crosshead speed of 0.1 mm min-1 the root segment
PREPARATION OF TEETH was loaded to fracture.

The root tip was flattened using a diamond bur in a high-

c,-, | ,~ A
speed handpiece. The tooth was then mounted vertically in
an aluminum ring by embedding the apical 3 mm in cold-
cure acrylic. The ring was then mounted in an Isomet low-
speed saw (Buehler, Lake Bluff, IL) and the crown of the
tooth was removed just below the cementoenamel junction.
Two slices 0.3 to 0.4 mm in thickness were then cut from the
cervical root dentin perpendicular to the long axis of the
tooth. Each prepared dentin slice was smoothed on 600 grit FiG 2. Diagrammatic representation of punch shear device for punch
silicon carbide abrasive paper. Both cross-sections were sub- shear strength and toughness testing. The cervical dentin sample (C)
sequently used for punch shear testing, with one section 0.3- to 0.4-ram thick was constrained between upper and lower dies
additionally used for microhardness testing. The remaining secured with two screws. A tungsten carbide rod (A) 0.993 mm in
root segment was trimmed, where necessary, to leave a seg- diameter was mounted in a tungsten carbide bush (B) located in the
center of the die. A load was applied to the rod at a crosshead speed
ment 8 mm in length, for loading to fracture (Fig. I). Using
of 0.1 mm min -1 until punching occurred.
a cone-shaped stone bur in a slow-speed handpiece, a l-ram
deep seat was then cut in the coronal opening of the root
canal for seating of the loading device. A comparator employing a micrometer reading to 0.01
mm was used to measure the thickness of each section buc-
PUNCH SHEAR TESTING cally and lingually at a distance mid-way between the root
canal and the periphery of the section. The dentin slice to be
punched was positioned over the bush of the lower die. Care
Punch shear strength (MPa) is the maximum stress that a
was taken to ensure accurate positioning of the test site over
material can withstand before failure in a punch shear mode
the punch hole. All tests were performed at least 1.0 mm from
of loading. Toughness (MJ/m -3) is defined as the energy
the specimen periphery and root canal edge on buccal and
required to fracture a material, and is measured as the area
lingual aspects. The upper die was then placed over the lower
under the elastic and plastic portions of a stress-strain curve.
die and secured so that the dentin section was constrained. A
A punch shear apparatus similar to that described by Carter
load was applied to the punch at a constant crosshead speed
et al. (8) (Fig. 2) mounted on a Shimadzu universal testing
of 0.1 mm min -~ until punching had occurred, as determined
machine (Autograph IS-5000; Shimadzu, Seisakusho Ltd.,
from the chart recording. Two tests were performed per
Kyoto, Japan) was used. The apparatus consisted of two
section. Punch shear strength and toughness values were
cylindrical steel dies aligned together with four dowels and
calculated as described by Carter et at. (8), with correction for
secured with two screws. A tungsten carbide bush was
machine compliance. The mean punch shear strength and
mounted within the central axis of the upper and lower dies,
toughness for each tooth were then calculated.
and a cylindrical tungsten carbide rod was used as a punch
(type 522; Pr~isionswerkzeuge GmhH, Ravensburg, West
Germany). The internal diameter of the upper bush was 1.000 LOAD TESTING
mm and of the lower bush 1.050 mm. Punch diameter was
0.993 mm. Concentricity between the punch and the bush of The root segment was positioned vertically on the lower
the lower die was confirmed by making an impression of the platen of the Shimadzu testing machine with the coronal face
punch and die on polyester film which was then viewed under upward. A cylindrical hardened steel rod attached to the upper
x6 magnification. crosshead was lowered until the cone-shaped point of the rod
334 Sedgley and Messer Journal of EndodonUcs

rested in the prepared coronal root face seat (Fig. 1). Using a
constant crosshead speed of 0.1 m m min-~ each root segment
was loaded to fracture.
MICROHARDNESS TESTING
One dentin slice per tooth was glued to a glass slide (Petro-
graphic Slides; Buehler) with epoxy resin (Araldite Super
Strength Epoxy Resin; Selleys Chemical Co. Pry Ltd., Pad-
stow, NSW, Australia) and polished (Minimet Polisher; Bueh-
ler) until all scratches created by the saw were removed. The
specimen was wet polished on 600 grade silicon carbide paper,
followed by Texmet Cloth (Buehler) and Microcloth (Buehler)
with diamond polishing paste. Microhardness of dentin was
measured using a microhardness tester (Leitz MINILOAD-
Hardness Tester; Ernst Leitz G m b H Wetzlar, FRG) under a
100-g load, and the Vickers Hardness Number was obtained.
Each pair was tested at identical sites. Three indentations
were made mid-way between the root canal and the periphery
of the specimen on both mesial and distal aspects, and the
mean value was calculated. The thickness of all slices exceeded
1.5 times the length of the diagonal of the indentation pro-
duced.
maining 20 pairs, 11 were from females and 9 from males.
Patient ages ranged from 21 to 72 yr with a mean of 47.2 yr.
Time since endodontic treatment ranged from 1 to 25 yr with
a mean of 10.1 yr; only four teeth had been treated less than
5 yr previously. The teeth tested were maxillary central incisor
(n = 6), maxillary lateral incisor (n = 5), maxillary canine (n
= 4), maxillary first premolar (n = 2), maxillary second
premolar (n = 3), maxillary second molar (palatal root) (n =
1), mandibular canine (n = 1), and mandibular third molar
(single rooted) (n = 1). All teeth were extracted for prosthetic
reasons. None of the endodontically treated teeth were re-
moved because of failure of endodontic treatment.
The mean punch shear strength, toughness, hardness, and
load at fracture are shown in Table 2. There were no statisti-
cally significant differences between endodontically treated
and contralateral vital teeth in punch shear strength (p =
0.710) and toughness (p = 0.089). Despite a difference in
hardness of only 3.5 %, vital teeth were highly significantly (p
= 0.002) harder than contralateral endodontically treated
teeth. Two samples for load testing were lost during processing
and the data for their matched pairs were excluded from
further analyses. The load to fracture values were not signifi-
cantly different between the two groups (p = 0.149).

Effect of Storage on Physical Properties DISCUSSION

Eight matched pairs of vital teeth were obtained as before,
but with crowns unrestored and intact. Patient age and sex
were recorded. One tooth of each pair was tested immediately
after extraction for punch shear strength, toughness, and load
to fracture as described above. The contralateral tooth was
tested 3 months later following storage in sterile-buffered
saline plus 0.05% sodium azide. Microhardness testing was
not performed.
Statistical Analysis
The clinical concept of "brittle" or weakened endodonti-
cally treated teeth has been attributed to loss of tooth structure
following trauma, caries, endodontic access, instrumentation
and irrigation procedures, and/or to changes in properties of
teeth following endodontic treatment (3, 6, 8). Although
Heifer et al. (6) reported a 9% lower water content of pulpless
teeth versus vital teeth, few studies have compared the bio-
mechanical properties of dentin of endodonticaUy treated
teeth with vital teeth (7, 8, 11). The only report of a difference

The data for each property tested were subjected to paired TABLE 1. Effect of storage on biomechanical properties of
t test analysis. For punch shear strength, toughness, and teeth*
hardness, paired t tests were performed on the mean values Immediate Three-Month
obtained for each tooth. Testing Storage P

Punch shear strength 64.97 __+7.91 63.63 __ 9.99 = 0.733

RESULTS (MPa)
Punch shear toughness 35.16 +_ 3.49 33.09 +_ 5.72 = 0.267
Effect of Storage on Physical Properties (MJ/m -3)
Load to fracture (N) 724 _+ 206 642 -+ 187 = 0.215
Eight matched pairs were obtained from four males and • All values represent mean -+ SD for eight matched.pairs.
three females. Patient ages ranged from 21 to 60 yr with a
mean of 40.5 yr. The teeth tested were maxillary central
incisor (n = 4), maxillary lateral incisor (n = 2), maxillary TABLE 2. Comparison of properties of endodontically treated
canine (n = 1), and mandibular canine (n = 1). There were versus contralateral vital teeth*
no significant differences between the two groups in punch Endodontically
shear strength, toughness, and load to fracture (Table 1). Treated Teeth Vital Teeth p
These results indicated that data from teeth stored for up to
3 months after extraction could be included in the subsequent Punch shear strength 70.42 _+ 12.39 69.76 ___11.69 = 0.710
(MPa)
analyses.
Punch shear toughness 42.51 + 10.38 40.08_+ 8.91 = 0.089
(MJ/m -3)
Endodontically Treated versus Vital Teeth Microhardness(Vickers 66.79__ 4.83 69.15 + 4.89 = 0.002
hardness no.)
Data on patient age, sex, and time since endodontic treat- Load to fracture (N) 611 ___148 574 ___153 = 0.149
ment were unavailable for three matched pairs. Of the re- • All values represent mean _+ SD for 23 matched pairs.
Vol. 18, No. 7, July 1992
in properties between endodontically treated and vital teeth
(8) was based on six endodontically treated teeth. Stanford et
al. (7) reported no difference in compressive properties (mod-
ulus of elasticity, proportional limit, and strength) of three
matched pairs, hut details of previous endodontic treatment
were unavailable. Although not eliminating all dissimilarities,
the use of matched pairs in our study allowed a reduction in
certain variables usually associated with testing extracted hu-
man teeth. Additionally, the larger number of matched pairs
and the range of tooth type compared with previous studies
provided the opportunity to make a broader assessment. The
mean time since endodontic treatment (10.1 yr) should have
been sufficient for any structural changes in dentin to have
occurred.
Punch shear strength and toughness values were in the
lower range of what has been previously reported (8, 9, 14).
Differences between our study and previous work with respect
to sample thickness, punch diameter, and the use of con-
strained samples could account for these differences, although
Carter et al. (8) reported an increase in values of samples
constrained during testing. The microhardness measurements
obtained in this study agree well with those of previous
investigators (11, 15, 16). Although we found that microhard-
ness values for vital teeth were statistically significantly higher
than those for contralateral endodontically treated teeth (p =
0.002), this small difference (3.5%) is unlikely to be clinically
significant.
A comparison of vertical load to fracture of endodonticatly
treated teeth and contralateral vital teeth has not been previ-
ously reported. Clinically, vertical root fractures are a com-
mon means of failure of endodontically treated teeth and are
thought to result from the trauma associated with lateral
condensation procedures and pin/post placement in endo-
dontically treated teeth (17). An in vitro study by Pitts et al.
(18) found that vertical root fractures occurred using large
spreaders under minimum loads of 7.2 kg in maxillary central
incisors. The testing procedure of our study attempted to
simulate vertical root fracture by applying a wedging load to
the coronal face of the root segment until longitudinal fracture
occurred.
There are several problems associated with the mechanical
testing of dentin. These include obtaining sound develop-
mentally normal teeth that have not been damaged during
extraction, cutting small pieces of dentin from the tooth
without creating thermal or mechanical damage, and the
unknown effects of storage media and time. The effects of
storage on biomechanical testing of dentin have not been
extensively reported. Carter et al. (8) found that different
storage media (tap water or mineral oil) did not affect shear
strength and toughness results but that dry storage signifi-
cantly increased values for mandibular incisors. In our study
it was apparent that 3-month storage in sterile saline did not
affect the values obtained. Other testing procedures may be
more sensitive to potential postextraction changes. Causton
et al. (13) found that storage affected the bond shear strength
between polycarboxylate cement and human dentin and sub-
sequently suggested that testing of dentin should take place
within 20 min of tooth extraction. However, the preparation
procedures necessary for testing of dental tissues may require
longer working times.
We have attempted to answer the question of whether the
loss of a vital pulp, resulting in subsequent loss of the nutrient
Brittleness of Teeth 335
supply to dentin, could lead to progressive changes in the
biomechanical properties of dentin. The results of this and
other investigations suggest that this is not the case (10, 12).
The similarity between the biomechanical properties of en-
dodontically treated teeth and their contralateral vital pairs
suggests that other factors may be more critical to failure of
endodontically treated teeth. Reeh et al. (5) showed that the
endodontic access cavity produced only a 5% decrease in
stiffness, in contrast to an MOD preparation which decreased
tooth stiffness by 63%. We suggest that it is rather the cu-
mulative loss of tooth structure from caries, trauma, and
restorative and endodontic procedures that leads to suscepti-
bility to fracture. Another possibility that has been suggested
but never extensively explored is that loss of pressoreception
(19), or an elevated pain threshold (20) allows larger loads on
endodontically treated teeth without triggering a protective
response.
This project was supported by a grant from the National Health and Medical
Research Council of Australia and was based on a thesis submitted to the
University of Melbourne in partial fulfillment of the requirements for the MDSc
degree.
The authors gratefully acknowledge the technical assistance of David Chea-
die and Koren Mitchell of the School of Dental Science, University of Melbourne,
Melbourne, Australia.
Dr. Sedgley is a graduate student in endodontics, School of Dental Science,
University of Melbourne, Melbourne, Australia. Dr. Messer is professor of
Restorative Dentistry, School of Dental Science, University of Melbourne.
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