Journal of Oral Rehabilitation 2003 30; 785–789
Clinical evaluation of a carbon fibre reinforced carbon
endodontic post
P. A. KING*, D. J. SETCHELL† & J. S. REES*
†
School, Bristol and Department of Conservative Dentistry, Eastman Dental Hospital, Institute of Dental Surgery, London
SUMMARY This study reports a prospective clinical
trial comparing a carbon fibre reinforced carbon
(CFRC) endodontic post with a conventional pre-
fabricated post. Twenty-seven single rooted maxil-
lary anterior teeth in 18 patients (nine males and
nine females; age range 18–60 years) were restored
either with a CFRC post or a wrought precious alloy
control. Cast type III gold alloy cores were used in
conjunction with both post groups. The CRFC posts
(n ¼ 16) were cemented with a composite luting
Introduction
Root filled anterior teeth have traditionally been
restored with cast or wrought metal posts and cores.
Some workers have suggested that as these metallic
materials have a much higher elastic modulus than the
supporting dentine, then this mismatch in the modulus
could lead to stress concentrating in the cement lute,
leading to failure. This has led to a search for a plastic-
based material that has a modulus closer to that of
dentine (Brown, 2000).
One non-metallic material that seems promising as a
post-material is carbon fibre (Isidor et al., 1996;
Manocci et al., 1999) and both plain carbon fibre posts
and carbon fibre posts coated with quartz are also
commercially available*. Dean et al. (1998) carried out
an in vitro comparison of carbon fibre with conventional
cast posts. They found that no root fractures were
associated with the carbon fibre post, whereas with a
cast post 50% of the teeth had root fractures.
*Bisco, Schaumberg, IL, USA.
ª 2003 Blackwell Publishing Ltd
*Division of Restorative Dentistry, University of Bristol Dental
agent and the conventional posts (control) were
cemented with zinc phosphate.Four failures were
recorded in the CFRC post group at 24, 29, 56 and
87 months, compared with one failure in the control
group at 84 months.These results suggest that post-
retained crowns utilizing a CFRC material and a
composite resin luting agent do not perform as well
as conventional wrought precious alloy posts.
KEYWORDS: post crowns, endodontics, carbon fibre
posts
A reinforced version of carbon fibre, known as carbon
fibre reinforced carbon (CFRC), has also been studied.
When the principal fibres are aligned at an angle to the
principal axis of the composite, a high elastic modulus
and transverse strength is possible. Hobkirk (1982) has
highlighted the good biocompatibility of CFRC and
Lovell (1983) demonstrated the compatibility of com-
posite resin with CFRC and suggested that it may be
suitable for a post and core system. This was further
enhanced when it was found possible to cast both noble
and non-noble alloys onto CFRC with no evidence of
disruption to the carbon fibre pattern.
King and Setchell (1990) carried out an in vitro
evaluation of CFRC as a potential post material. They
compared a CFRC post with either a cast gold core or a
composite resin core. They found that the CRFC post
restored with either a gold core or a composite core
gave good resistance to fracture but favoured the CRFC
post with a gold core because the mode of fracture with
the gold core was more favourable to the remaining
tooth substance.
They concluded that ‘on the basis of the experimental
results a CFRC prefabricated post could be considered
785
786 P . A . K I N G et al.
for a restricted clinical trial’. This paper reports the
results of the prospective clinical trial suggested by the
initial in vitro work of King and Setchell (1990).
Materials and methods
Twenty-seven single rooted maxillary anterior teeth in
18 patients (nine males and nine females; age range 18–
60 years) were restored either with a CFRC post or a
wrought precious alloy control† (See Fig. 1)
The selection criteria for inclusion in the study were
that all teeth were single-rooted maxillary teeth where
a post-retained crown was clinically indicated. All teeth
for inclusion in the study had to have an adequate root
filling with no evidence of any periapical pathology,
perforation or root fracture. The periodontium was
Fig. 1. Carbon fibre reinforced carbon (CFRC) post (left) and
wrought precious alloy Parapost.
† §
Parapost, Coltene ⁄ Whaledent Ltd, Burgess Hill, W Sussex, UK.
ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 785–789
examined using a Williams probe using four probing
sites per tooth and patients were only included in the
trial when the periodontium was stable with no
evidence of bleeding on probing and a minimum of
75% bone support.
Teeth that were potentially abutments for a fixed or
removable prosthesis were excluded. Patients were also
excluded from the study if there was a lack of adequate
posterior support, defined as absence of all molar teeth,
or if there was an obvious occlusal interference or
fremitus affecting the tooth to be restored.
Patients were allocated to either of the experimental
groups using the following randomization process.
Where possible, patients were recruited to the trial that
required two post crowns. In this circumstance, the
materials were allocated using ‘the toss of a coin’.
Where patients only required one crown, the material
type was allocated on an alternate basis starting with
the CFRC post.
All teeth were prepared in a standard clinical manner
with rotary instruments by a single operator (PAK).
Excess gutta percha was removed from the root canal
using heated instruments and the post hole was
prepared by using increasing sizes of Parapost twist
drills. A maximum size of 1Æ25 or 1Æ5 mm was used,
depending on the size of the tooth; 1Æ25-mm posts were
used in upper in lateral incisors and 1Æ5-mm posts were
used in upper canines and central incisors.
An anti-rotational feature was achieved by enlarging
the natural eccentricity of the root canal. All internal
line angles were smoothed and coronal dentine was
preserved where possible. A shoulder finish was used
labially and a chamfer finish palatally for all teeth.
Using the Parapost preformed plastic patterns, addi-
tional silicone impressions were taken of the prepara-
tions. Acrylic resin crowns, cemented with a eugenol
free cement‡ were used for temporization. The impres-
sions were then poured with a die stone and from the
resultant casts customized wax patterns of the antiro-
tational feature and cores were built-up on the prefab-
ricated posts. Using the lost wax technique type III gold
alloy cores were cast in combination with both post
groups and the same technician constructed all posts
and crowns (see Fig. 2).
The CRFC posts (n ¼ 16) were cemented with a
composite luting agent§. The controls (n ¼ 11) were
‡
Tempbond NE, Dentsply Ltd, Weybridge, Surrey, UK.
Conclude, 3M Dental Division, St. Paul, MN, USA.
 EVALUATION OF A CARBON FIBRE POST 787

Fig. 3. UL1 is a carbon fibre reinforced carbon (CFRC) post, the

UL2 is a wrought post.

Fig. 2. Left post is carbon fibre reinforced carbon (CFRC), right

post is precious alloy core on a wrought post.

cemented with a zinc phosphate cement¶ mixed

according to the manufacturers instructions. The post
holes were thoroughly cleaned with a 3% hydrogen
peroxide solution for 15 s irrigated with saline and
dried with paper points, prior to introducing the cement
into the canal with a rotary instrument. No interme-
diate bonding agent was used with Conclude, as no
suitable chemically curing material was available at the
time.
Following post-cementation, the preparations were
further refined and a further addition silicone impres-
sions were taken for the laboratory construction of
metal-ceramic crowns with a ceramic butt finish on the
labial aspect. All crowns in both groups were cemented
with zinc phosphate cement. A baseline periapical
radiograph was taken once each crown had been
cemented. A clinical and radiological illustration of
the post crowns is also shown in Figs 3 and 4.
Recall examinations were made at 1, 3 and 6 months
and thereafter at yearly intervals. Periapical radiographs
of each tooth were also taken at each annual recall.
Each recall examination was carried out by one
examiner (PAK) and the restored teeth were examined
¶
Ash CAS, AD International, Potters Bar, Hertfordshire, UK.
Fig. 4. Radiograph of carbon fibre reinforced carbon (CFRC) post
in UL1. Note that the CFRC post shows no opacity.
under ·2Æ5 magnification using magnifying loupes.
Restorations were judges to have failed if each post
crown satisfied one or more of the following criteria:
(i) Movement of the crown margin under finger
pressure, (ii) Recurrent caries detected at the crown
margin, (iii) Fracture of the restoration, (iv) Fracture of
the root and (v) Periapical or periodontal pathology
requiring crown removal.
Results
An outline of the clinical performance of each of the
CRFC and conventional gold posts is given in Table 1.
The mean observation period for all patients was
87 months (range 80–100). In the CFRC group two
patients were lost to recall at 16 and 31 months.
Similarly, two patients in the conventional post group

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 785–789

788 P . A . K I N G et al.

Table 1. Clinical evaluation data

Evaluation
period (months) Outcome Remedial action

Carbon fibre reinforced carbon (CFRC) data

97 Still in function
100 Still in function
99 Still in function
29 Cementation Recemented with
failure zinc phosphate
67 Still in function
89 Still in function
24 Cementation failure ⁄ Remade gold post ⁄ core
caries
80 Still in function
87 Cementation failure Recemented with
zinc phosphate
56 Cementation failure Recemented with
zinc phosphate
85 Still in function
80 Still in function Fig. 5. Typical failure showing cementation failure between the
80 Still in function resin lute and the internal dentine.
85 Still in function
16 Lost to recall
31 Lost to recall
the survival of the CFRC posts is lower than the
conventional posts from 24 months, which was the
Gold alloy post data
time to failure for the first CFRC post to fail.
84 Fractured post Overdenture
abutment
98 Still in function
Discussion
85 Still in function
90 Still in function Overall, the failure rate for the CFRC posts was higher
80 Still in function
than for the prefabricated posts as is obvious from the
87 Still in function
80 Still in function
survival curve (Fig. 6). In all the failed CRFC cases, the
85 Still in function patients reported increasing mobility of the tooth and
85 Still in function on examination, movement of the crown margin was
19 Lost to recall detected. Removal of the intact post-retained crown
24 Lost to recall was possible demonstrating no mechanical disruption
of the CFRC post and ⁄ or root fracture. Bond failure

were lost to follow-up at 19 and 24 months. The two

patients in each group lost to recall were not included
in the subsequent statistical analysis.
In the CFRC group, four failures were recorded at 24,
29, 56 and 87 months. The mode of failure in all cases
was because of loss of cementation. An example of such
a failure is shown in Fig. 5. In the control group only
one failure was observed at 84 months.
The overall survival rates for the CFRC group was
71% (10 of 14) compared with an overall survival rate
of 89% (eight of nine) for the conventional prefabri-
cated group.
Figure 1 shows the Kaplan–Meier survival curves for Fig. 6. Survival curve for carbon fibre reinforced carbon (CFRC)
the CFRC and conventional gold posts. As can be seen, and wrought alloy ⁄ gold core posts.

ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 785–789

 EVALUATION OF A CARBON FIBRE POST
appeared to have occurred between the composite resin
luting cement and the internal root dentine in all
restorations, with resin evident on the post and core,
but little on the dentine surface. It was not possible to
determine whether bond failure was because of poor
material selection, lack of a dentine bonding agent or
dentine contamination.
A further factor to consider are the findings of a
recent study carried out by Clinical Research Associates
(CRA, 1998). They found that the strength of carbon
fibre posts decreased by as much as one-third when
soaked in water for 24 h prior to testing. It is therefore
possible that during clinical function the CFRC posts
absorbed water slowly from the surrounding tissues by
diffusion, resulting in a reduction in strength which
may have contributed to their early clinical failure.
In three of the four CFRC failures the coronal tooth
tissue was intact and the post-retained crowns were
recemented using zinc phosphate as an alternative
luting cement. Interestingly, since recementing these
posts with zinc phosphate cement all restorations were
still performing well at the conclusion of this evaluation.
In conclusion, these results suggest that post-retained
crowns utilizing a CFRC material and a composite resin
luting agent do not perform as well as conventional
wrought precious alloy posts. However, these results
must be interpreted with a certain amount of caution
because of the relatively small sample size used in this
ª 2003 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 30; 785–789
789
study. Furthermore, the use of a contemporary dentine
adhesive in conjunction with a resin luting cement may
contribute to the retentive properties of CFRC posts.
References
BROWN, D.A. (2000) Fibre-reinforced materials. Dental Update, 27,
442.
CLINICAL RESEARCH ASSOCIATES (1998) Post Strength Tests, November,
p. 1.
DEAN, J.P., JEANSONNE, B. & SARKER, N. (1998) In vitro evaluation of
a carbon fibre post. Journal of Endodontics, 24, 807.
HOBKIRK, J.A. (1982) The response of bone to carbon fibre
reinforced carbon implants. In: Clinical Applications of Biomate-
rials, p. 109. J Wiley and Sons Ltd, Cichester.
ISIDOR, F., ODMAN, P. & BRONDUM, K. (1996) Intermittent loading of
teeth restored using prefabricated carbon fibre posts. Interna-
tional Journal of Prosthodontics, 9, 131.
KING, P.A. & SETCHELL, D.J. (1990) An in vitro evaluation of a
prototype CFRC prefabricated post developed for the restoration
of pulpless teeth. Journal of Oral Rehabilitation, 17, 599.
LOVELL, M.J. (1983) The bond between CFRC and restorative
materials. MSc Thesis, University of London.
MANOCCI, F., FERRARI, M. & WATSON, T.F. (1999) Intermittent
loading of teeth restored using quartz fibre, carbon-quartz fibre
and zirconium dioxide ceramic root canal posts. Journal of
Adhesive Dentistry, 1, 153.
Correspondence: Dr J. S. Rees, Division of Restorative Dentistry,
University of Bristol Dental School, Bristol, UK.
E-mail: j.s.rees@bristol.ac.uk