Load Fatigue of

Teeth Restored With

Cast Posts and Cores and
Complete Crowns
Warren I. Libman, DDS, MSD'
jack I. Nicholls, PhD*'
Department of Restorative Dentistry
School of Dentistry
University of Washington
Seattle, Washington
Twenty-five extracted human central incisors were divided into five groups
and prepared for complete cast crowns. Test teeth had cast dowel cores
fabricated with the ferrule height varying from 0.5 to 2.0 mm in 0.5-mm
increments. The five control leeth did not have cast dowel cores. A 4.0-kg
load was applied to each of the restored teeth at an angle of 135 degrees to
the long axis of each tooth. This load was applied cyclically at a rate of 72
cycles per minute. The load application point was predetermined by a
waxing jig that was used to wax all crowns. The primary variable was the
ferrule length. The independent variable was the number of load cycles
required to create preliminary failure. Preliminary failure was defined here as
the loss of the sealing cement layer between crown and tooth. An electrical
resistance strain gauge was used to provide evidence of preliminary failure.
The results of this study showed that the 0.5 mm and 1,0 mm ferrule lengths
failed at a significantly lower number of cycles than the 1.5 mm and 2.0 mm
ferrule lengths and control teeth. Int J Proithodont I995;8:l 35-16!.
R
esearch has clearly disputed the belief that
foundation restorations reinforce endodonti-
cally treated teeth.'"* It has been suggested, how-
ever, that they provide a replacement for lost
tootb structure to increase the retention and
resistance form of a complete crown prepara-
ti on.' ^ Various foundation materials and tech-
niques have been directly tested for retention and
resistance to fracture. Clinically, however, the
differences are of l i mi ted significance, since
foundations are often covered by crowns that
have been shown to negate these differences.'-^
The marginal area of a complete crown when
extended onto the tooth structure beyond these
foundation materials creates a ferrule. The ferrule
Is defined as a metal band or ring used to fit the
root or crown of a tooth.' Fatigue is tbe breaking
'Acting Assistant Professor.
"Professor.
Reprint requests: Dr ack I. Nicholls, Department of Restorative
Dentistry, 5choo! of Dentistry SM-56, University of Washington.
Seattle, Washington 9B195.
or fracturing of a material caused by repeated
cyclic or applied loads below the yield l i mi t.'
Intraoral occlusal forces create this dynamic
repetitive loading; thus, instead of a monotonie
static load to fracture, it would be more clinically
relevant to test specimens under a physiologic
fatigue load.
Fatigue life is a term used explicitly in fatigue lit-
erature to define the number of load cycles
required to fail a specimen for a given applied
load. In this research, fatigue life refers to a prelim-
inary failure condition as opposed to complete
fracture of the specimen. This preliminary failure is
defined as the point at which a failure of the luting
cement occurs that cl i ni cal l y wi l l result in
microleakage between the crown and the tooth,'"
Such microleakage may eventually be manifested
as recurrent caries, loss of retention, fractured
posts, or complete dislodgment of the crown and
foundation restoration." "
This research investigated maxillary central
incisors restored with cast posts and cores and
complete cast crowns. Four different ferrule lengths
were investigated: 0.5 mm, 1.0 mm, 1.5 mm and
^I.; B, Number 2, 1995 155 The Iniernaiional iournal of Prosthodonlii
Load Fstigue ol Cast Posts ^ Cores and Complete Caii Crowns
2.0 mm. Preliminary failure defined the comple-
tion of each test. The controls were central incisors
wi th complete cast crowns, without posts and
cores.
Materials and Methods
Test Croups
Twenty-five extracted human maxillary central
incisors were used in this study. These teeth were
selected on the basis of lack of cracks, fractures or
caries in the cervical area or root. The teeth were
kept hydrated in room temperature distilled water
prior to the study, and were wrapped in a wet
gauze during tooth preparation. All fatigue testing
was carried out with the teeth immersed in room-
temperature water.
The teeth were randomly divided into five
groups of five teeth each:
Control, No cast post and core, restored with
complete cast crowns.
Croup 1. Restored with cast posts and cores and
complete cast crowns with a 0.5-mm ferrule.
Group 2. Restored with cast posts and cores and
complete cast crowns with a 1.0-mm ferrule.
Group 3. Restored with cast posts and cores and
complete cast crowns with a 1.5-mm ferrule.
Group 4. Restored with cast posts and cores and
complete cast crowns with a 2,0-mm ferrule.
Figure 1 shows these five groups diagrammatically.
Post and Cores Fabrication
All teeth in the four experimental groups had the
coronal section removed level with the proximal
CFJ, using a supercoarse diamond instrument
(Brasseler USA, Savannah, GA) and copious irriga-
tion. This prepared surface was further refined using
wet 600 grit abrasive paper creating a planar sur-
face perpendicular to the long axis ofthe root. The
canal space was then prepared to a depth of 8 mm
from the occlusal flat prepared surface to a final
diameter of 0.05 inches (1.25 mm) using twist drills
(Goitene/Whaledent, Mahwah, N|). An antirota-
tional notch measuring 1.0 mm occlusoapically
and 1.0 mm buccolingually was placed in the top
flat surface on the lingual of the canal space prepa-
ration. The sharp junction between the top flat sur-
face and the canal preparation was beveled with a
green stone (Shofu, Menlo Park, CA). Three reten-
tive notches were placed in the external root sur-
face of each tooth to hold the tooth firmly in the
holder during fatigue testing. Each tooth was
Libmjn/Nicholls
attached to a surveyor rod and lowered into the
center of a machined aluminum cylinder which
acted as the holder. The center of the post space
was parallel to the axis of the machined cylinder.
All teeth were embedded to a specific depth in their
individual aluminum cylinders and retained with
autopolymerizing resin (Duralay, Reliance, Worth,
IL). Teeth were positioned with the crown margin
2.5 mm above the resin surface.
A 1.25-mm plastic burnout pattern (Goltene/
Whaledent) was inserted into the 8-mm prepared
canal space and a custom post and core pattern
was constructed using autopolymerizing resin (GC
Pattern Resin, GC America, Scottsdale, AZ). The
teeth wi th the foundation restorations in place
were then prepared for complete crowns using a
coarse diamond instrument (Brasseler 6847/016).
The preparation was refined under lOX magnifica-
tion using a Brasseler 8847/016 fine diamond. The
control teeth which had no foundation restoration,
had a preparation height of 6.0 mm. The core por-
tion of the post and core restoration on all experi-
rnental teeth was 6.0 mm in height. On the experi-
mental teeth the preparation finish lines were
located 0.5 mm, 1.0 mm, 1.5 mm, and 2,0 mm
apical to the core, giving preparation heights of 6.5
mm, 7.0 mm, 7.5 mm, and 8.0 mm, respectively. It
should be noted here that provi di ng a ferrule
length increase for the tooth with a questionable
ferrule may be achieved in one of two ways: (1> by
periodontai crown lengthening, or (2) by orthodon-
tic extrusion. Since crown lengthening seems to be
the more commonly used procedure, this was used
in this study. In doing so, however, the cast crowns
increased in occl usocervi cal di mensi on wi t h
increasing ferrule length.
The finish lines were circumferential shoulders
1.0 mm in width. The ferrule height was measured
at eight locations around the periphery of the
preparation during the refining procedure. All mea-
surements were made with a dial caliper having an
accuracy of 0.005 mm and measured using 10X
magnification. The ferrule was measured at eight
locations around the preparation, and an experi-
mental accuracy of 0.05 mm obtained. The pat-
terns were invested (Complete, JF Jelenko. Armonk,
NY) and cast (Midigold Hard, Ivoclar/Williams,
Buffalo, NY). The castings were then inspected
under 20X magnification and adjusted to assure a
passive fit. The cast dowel cores were then air-
borne particle abraded using 25 \irr\ aluminum
oxide under 3 kg/cm' pressure and luted under fin-
ger pressure using zinc phosphate cement (Fleck's,
Mizzy, Cherry Hill, NJ) mixed according to manu-
facturer's directions.
The International oiirnal of Prosthodontics 1 5 6 Volume B, Nu.
bmaiVN icholl s Load Fatigue o Cssl Posts & Cotes a ntl Complete Cast Crowns
Control Group 1
Group 2 Group 3 Group 4
Fig 1 Diagrammatic representation of the four test groups and the control group.
Cast Crown Fabrication
Impressions of the final tooth preparations were
made using a polyether impression material
(Impregum, ESPE/Premier. Norristown, PA) and
poured in Type IV dental stone (Fujirock, CC
America), Two coats of die spacer (PDQ, Whip
Mix, Louisville, KY) were applied to the dies, 'vVax
copings (Maves #3 Inlay wax, Maves, Cleveland,
OH) were fabricated on the dies and were trans-
ferred to the corresponding test specimens, which
were positioned in a custom waxing jig (Fig 2).
This waxing jig provided a standardized location
or notch for the gold crown where the fatigue load
was to be applied. This notch was located 1,0 mm
incisai to the incisai edge of the core (see Fig 1).
After waxing the notch location, each pattern was
transferred back to the appropriate die, and the
crown contours were completed, invested, and
cast. Following casting and devesting, the crowns
were inspected under 20x magnification for fit.
When fit had been ascertained, the internal of the
crowns was airborne particle abraded using 25 |jm
aluminum oxide under 3.0 kg/cm- pressure. The
crowns were cemented to the teeth wilh zinc phos-
phate cement, mixed according to manufacturer's
directions. During tbe cementing procedure, each
crown was held in place for 10 minutes under a
10- kg load.
Fig 2 Waxing ig showing notch where fatigue load was
applied.
Tooth Dimensions
Prior to iuting of the post and core, the bucco-
lingual dimensions of each tooth at the crown fin-
ish lines were measured and recorded.
Fatigue Loading Device
The fatigue loading device was designed and
fabricated at the University of Washington, and has
been previously described,'' In keeping with the
157
The Inlemalional [ournal of ProBl
Losd Fatigue of Cast Po^is and Complete Cast
Fig 3 Strain gauge on lingual surface
of a test tooth.
loading conditions applied in vivo, the teeth used
in this study vi'ere subjected to a fatigue load
applied at an angle of 135 degrees to the long axis
of the tooth," A 4-kg load was applied to the load-
ing notch on each of the test crowns at a frequency
of 72 cycles per minute." This load is within the
range of physiological masticatory f orces, "" All
test and control teeth were immersed in a room-
temperature water bath during fatigue loading.
Strain Gauges
The strain gauges (EA-06-062AP 120, Micro-
Measurements Division of Measurements Group,
Raleigh, NC) had an internal electrical resistance
of 120 ohms, and had a grid size of 0,062 inches
{1,6 mm).
The lingual crown/tooth interface was lightly
ground with a diamond disk to create a flat surface
and airborne particle abraded using 25 \rr\ alu-
minum oxide at a pressure of 3 kg/cm'. This sur-
face was then cleaned with acetone, and a strain
gauge was cemented to place using M-Bond strain
gauge cement IMicro-MeasurementsI ensuring that
the strain gauge grid was cemented over the
tooth/crown interface. Following cementation,
wires were soldered to the strain gauge terminals
{Fig 3), and the strain gauge was completely cov-
ered with impression tray adhesive {Mirror 3, Kerr
Manufacturing, Romulus, Mil to ensure exclusion
of water during fatigue testing.
Definition of Preliminary Failure
Preliminary failure was defined as the propaga-
tion of a crack in or around the luting cement
layer. This crack was initiated at the lingual margin
of tbe crown and propagated up tbe lingual axial
wall. From a feasibility study, it was found that the
existence of a crack and the micromovement of the
cast crown relative to the margin was not dis-
cernible to the unaided eye. Propagation of this
crack was visually observable in terms of the out-
put on a model 455V Goul d Chart Recorder
{Clevite Corporation, Cleveland, OH) monitoring
the strain gauge output.
Measurement of Preliminary Failure
The strain gauge on the lingual margin of the
tooth/crown interface was connected as one arm of
a Wheatstone Bridge circuit. According to the
mathematics of the Wheatstone Bridge, tbe voltage
output of this bridge is proportional to the move-
ment of the lingual margin of the crown with
respect to the finish line. This output voltage was
recorded on a Gould Chart Recorder {Clevite
Corporation), The tracing on this chart recorder
depicted the relative micro-movement between the
lingual margin of the crown and the finish line.
Initially, the recorded amplitude was small and
regular, with the tracing returning to zero when the
tooth was unloaded. This indicated that the move-
ment of the cast crown was elastic and that no
crack had formed in the cement. Once a crack in
the cement layer had formed, the amplitude of the
tracing on the Gould chart recorder increased.
Fi nal l y, the movement of the crown margin
reached a magnitude that was beyond the range of
the strain gauge, A diagrammatic representation of
the strain gauge output at preliminary failure is
shown in Fig 4,
Verification of a Failure Crack in the Cement
Layer
The failed teeth were examined under 20X mag-
nification, but no visible evidence of the existence
of a crack was seen. Verification of this crack was
obvious when a drop of water was placed on the
lingual margin and i ntermi ttent pressure was
applied to the crown whil e stabilizing the alu-
minum cylinder holder. Water was seen to pump
in and out between the tooth finish line and lingual
crown margin,
A visual method of indicating the extent of the
crack in the zinc phosphate cement was provided
The Interrational Journal of Prostliodontk 158
Volume e, N
Load FaligLe of Cast Posts & Cores and Complete Cast Cri
Strain gauge output
Crack formation in cement
Cyclic load application
Fig 4 Ttieoretical diagram ot strain gauge output at preliminary failure.
by immersing the test teeth in black ink Pelikan
Drawing Ink A, Pelikan AC, Germany) for 12
hours, then allowing the ink to dry for 6 hours.
Following this, the crowns were sectioned in the
mesiodistal plane wi t h a carborundum disk
(National Keystone, Cherry Hi l l , NJ|. The crown
was then separated from the t oot h, and the
microleakage pattern observed but not quantified.
Statistical Analysis
The independent variable recorded was the
number of load cycles to preliminary failure. This
variable was subjected to a one-way ANOVA, with
the Student-Newman-Keuls test used to define sig-
nificant subsets at the 95% confidence level.
Results
Table 1 shows the number of load fatigue cycles
required to create preliminary failure for each test
group- This table also contains the results of the
statistical analysis, with statistical subsets defined
by the vertical bars. These results are also shown in
bar graph form in Fig 5. The one-way ANOVA test
revealed that Croups 1 and 2 were significantly
different from Groups 3, 4, and tbe control group
(P< .05). It should be noted here that one sample
in the control group exhibited root fracture prior to
preliminary failure. Thus, only four samples for this
group were evaluated in the statistical analysis.
Table 1 Number of Cycles to Failure
Group
number
1
2
3
4
Control
Ferrule
length (mm)
0.5
1.0
15
20
-
Mean
113
1140
71,651
60,045
91,208
Standard
deviation
83
665
53,590
26,604
49,891
Statistical
subsets""
'Five samples in eacii group.
'Rool fractured occurred prior to preliminary faiijre in one sample.
' "Verti cal lines indicate subsets ttiat are significantly different
lP<.05|.
o
r 1
,. i
Ferrule length (mm
Fig 5 Number of load cycles to create preliminary failure.
159 a I of Prostliodontics
Load FatiUe ol Casi Posts S, Cores and Complte Cnt Cr.
Fig 6 Microleakage between the crown ferrule and tooth.
Fig 7 ivlicroleakage pattern showing leakage along the post.
Microleakage Evaluation
In all test groups, ink penetration occurred
between the crown margin and lingual tooth finish
line, up the ferrule, and into the tooth-core inter-
face (Fig 61. In some specimens there was evidence
of microleakage in the coronal portion of the post
space (Fig 7). In no instance was ink observed
between the crown and core.
Discussion
Earlier studies adopted a 2-mm ferrule length as
being necessary for long-term clinical success of
endodontically treated teeth.' "" For the conditions
applied in this study, the results suggest that the
minimum ferrule length for a central incisor should
be 1.5 mm, since there was a significant increase
in the number of load cycles to preliminary failure
when the ferrule length was increased from 1.0
mm to 1.5 (Table 11.
The number of cycles to preliminary failure was
correlated with buccolingual dimensions of the test
teeth. No significant correlation was found. There
was an unexpected drop in the number of cycles to
preiiminary failure when the ferrule length was
increased from 1.5 to 2.0 mm. Although not signifi-
cant, this drop may be explained by the greater
crown height associated with the 2.0 mm ferrule
that introdLtced a greater bending moment or dis-
lodging moment on the crown.
Preliminary failure did occur for the control
group even though the preparations were entirely
on tooth structure. The complete crown preparation
of the central incisor provides minimal resistance
form when loaded from the lingual (Fig 1|. Thus,
crown disiodgment is possible for this restoration.
Tbe microleakage evaluation showed leakage
patterns invading the ferrule, and progressing into
the tooth-core junction and the post space. These
observations are consistent with clinical findings of
caries at the tooth-core junction, and fractured
posts with the core and crown being dislodged as a
single unit."""
As with many in vitro studies, it is difficult to
extrapolate these results directly to the clinical situa-
tion. The elasticity of the periodontal ligament was
not duplicated, and the ferrule height was a constant
height around the periphery of the teeth. Teeth are
generally prepared, however, with their finish lines
following the coronal extension of the gingival tissue
level interproximally. Also, the ferrule height usually
varies around the circumference of the tooth.
In light of the results of this study, one should
certainly consider some modification in treatment
plan when a tooth presents with a ferrule of less
than 1.5 mm. This becomes even more important if
the final restoration will be subjected to a possible
load increase, as a fixed partial denture abutment,
for example, or an abutment for a distal extension
base removable partial denture. Periodontal crown
lengthening, or orthodontic extrusion, may be indi-
cated to increase the ferrule height.
Conclusion
Twenty-five central incisors were restored with
cast posts and cores and complete crowns, and
subjected to a cyclically varying (fatigue) 4-kg
load. These twenty-five teeth were divided into
four test groups and one control group according
to the ferrule length of the crown. The test groups
had ferrule lengths of 0,5 mm, 1.0 mm, 1.5 mm
The Intemalinral loiirnal of Frost hod on ties 160
Libman/Nichoils l.o.id F.KiKiie ct" Cast Posts , Cores and Complete Casi Crowns
and 2.0 mm. The control group had no cast dowel
cores. Loading of all specimens was continued
until preliminary failure occurred, when movement
between the crown and the tooth increased as a
result of crack formati on either la> at the
cement/crown interface, (b) at the cement/tooth
interface, or (c) in the cement. From the results of
this study the following conclusion may be made.
When the ferrule length was greater than or equal
to 1.5 mm, a significant increase in the number of
load cycles to preliminary failure was recorded
when compared to crowns having a ferrule length
less than 1.5 mm.
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The International lournal oi ProsthodontK