Journal of Biomechanics 46 (2013) 2572–2577

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Journal of Biomechanics
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www.JBiomech.com

Fracture resistance of endodontically treated teeth restored with

intra-radicular post: The effects of post system and dentine thickness
Ramiro Rocha Barcellos a, Débora Pereira Diniz Correia a, Ana Paula Farina a,
Marcelo Ferraz Mesquita b, Caio Cezar Randi Ferraz c, Doglas Cecchin a,n
a
Department of Restorative Dentistry, Passo Fundo Dental School, University of Passo Fundo, UPF, Passo Fundo, RS, Brazil
b
Department of Prosthodontics and Periodontology, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil
c
Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, UNICAMP, Piracicaba, São Paulo, Brazil

art ic l e i nf o a b s t r a c t

Article history: To investigate the influence of post system and amount of remaining root tissue on the fracture
Accepted 25 August 2013 resistance of endodontically treated teeth. Seventy upper canine teeth were divided into seven groups
(n ¼10), one control (sound teeth) and six experimental groups resulting from the interaction between
Keywords: the two study factors: post system (FB, fiber post; FPC, fiber post relined with resin composite; CPC, cast
Cast post and core Ni–Cr alloy post and core) and amount of remaining root tooth tissue (2 or 1 mm of thick root). All teeth
Endodontically treated teeth were restored with metal crowns and exposed to 250,000 cycles in a controlled chewing simulator. The
Fracture resistance samples were submitted to the fracture resistance test in a universal testing machine, at an angle of 1351
Glass fiber post and speed of 0.5 mm/min, until fracture occurred. Failure modes were observed, and the data of fracture
Root fracture
resistance, in Newtons, were submitted to the analysis of variance (ANOVA), followed by Tukey′s test
(α ¼0.05). Roots restored with FPC had the highest fracture strength of the experimental groups, being
statistically similar to the intact teeth group (P 40.05). FP and CPC did not differ statistically (P4 0.05)
and were statistically lower than those of FPC (Po 0.05). No statistically significant difference was
observed between amounts of remaining root tooth tissue to the same post systems (P4 0.05). A
prevalence of irreparable failures was observed in specimens restored with CPC, whereas FP and FPC
posts showed more repairable failures. The post system had an influence significant on fracture
resistance. However, the remaining dentine with 2- or 1-mm thickness was not an important factor
for the fracture resistance.
Crown Copyright & 2013 Published by Elsevier Ltd. All rights reserved.

1. Introduction
Endodontically treated teeth are structurally different from
nonrestored vital teeth and require specialized restorative treat-
ment (Al-Omiri et al., 2010). The loss of dentin, including anatomic
structures such as cusps and the arched roof of the pulp chamber,
can result in tooth tissue fracture after the final restoration (Belli
et al., 2005). In such cases, the use of intraradicular posts is
recommended to promote the retention of the final restoration
(Soares et al., 2008). A primary function of a post is to improve the
retention of the final restoration and to distribute occlusal stresses
along the remaining tooth structure. It has been demonstrated
that posts do not strengthen the tooth (Trope et al., 1985; Zicari
et al., 2013).
The fracture susceptibility of teeth restored with posts may be
related to factors such as the amount of remaining tooth structure,
n
Correspondence to: Universidade de Passo Fundo, Campus I, Faculdade de
Odontologia, BR 285, Km 171, Bairro São José, Caixa Postal 611, 99052-900 Passo Fundo,
Rio Grande do Sul, Brazil. Tel.: þ55 54 3316 8402; fax: þ55 54 3316 8403.
E-mail address: dgscecchin@yahoo.com.br (D. Cecchin).
which provides resistance to the fracture of the tooth (Ng et al.,
2006), and the characteristics of the post, such as the material
composition, modulus of elasticity, diameter, and length (Fokkinga
et al., 2006; Bacchi et al., 2013; Zhou and Wang, 2013). A root
fracture is the most serious type of failure in postrestored teeth
(Ferrari et al., 2000). To avoid root fractures, a post having a
modulus of elasticity similar to that of dentin helps in distributing
the stress of occlusal load in a uniform pattern (Fokkinga et al.,
2004; Maceri et al., 2007; Dietschi et al., 2008).
For a long time, cast metal post and core systems have been
used as intraradicular retention (Dietschi et al., 2008), but they
have disadvantages such as a high modulus of elasticity, increasing
the possibility of irrecoverable fractures of the remaining tooth
structure (Fokkinga et al., 2004; Nakamura et al., 2006; Zhou and
Wang, 2013). Prefabricated fiberglass posts have led to great
advancement, especially as regards mechanical properties, such
as high flexural strength and modulus of elasticity similar to that
of dentine, minimizing the transmission of stresses on the root
walls and decreasing the possibility of fractures (Fokkinga et al.,
2004; Lassila et al., 2004; Asmussen et al., 2005; Nakamura et al.,
2006; D'Arcangelo et al., 2008). Furthermore, fiberglass posts

0021-9290/$ - see front matter Crown Copyright & 2013 Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jbiomech.2013.08.016
 R.R. Barcellos et al. / Journal of Biomechanics 46 (2013) 2572–2577
are translucent, contributing to the esthetic qualities of tooth-
colored restorations (Qualtrough and Mannocci, 2003), and their
chemical composition is compatible with that of Bis-GMA mono-
mer, present in the adhesive systems and resinous cements
(Schwartz and Robbins, 2004; Farina et al., 2011). However,
because most clinical failures in teeth restored with fiber posts
occur because of postdebonding (Ferrari et al., 2000) in large root
canals with thin tapered walls (Iglesia-Puig and Arellano-Cabor-
nero, 2004), the use of the fiber post relined with resin composite
has been proposed, creating individualized intraradicular posts
with a better adaptation to root canals (Grandini et al., 2005;
Macedo et al., 2010).
Therefore, the aim of the study was to investigate the influence
of post system and amount of remaining root tissue on the fracture
resistance of endodontically treated teeth. The hypotheses were
that (1) post system influences on fracture resistance of root-filled
teeth and that (2) 2 mm of thick dentin has the highest fracture
resistance than 1 mm.
2. Materials and methods
Seventy extracted upper canines (gathered following informed consent,
approved by the Commission for Ethics of the University of Passo Fundo,
no. 044/2012) were stored at 37 1C in distilled water and used within 6 months
after extraction. The inclusion criteria were the absence of caries or root cracks and
the absence of previous endodontic treatments, posts, or crowns. Furthermore,
teeth of similar size and shape were selected by root dimensions after measuring
the height and buccolingual and mesiodistal widths in millimeters, allowing a
maximum deviation of 10% from the determined mean.
2.1. Endodontic treatment
Root canals that would receive posts were endodontically treated. All root
canals were prepared by one trained operator. Each tooth was decoronated below
the cementoenamel junction perpendicular to the longitudinal axis using a slow-
speed, water-cooled diamond disc (Isomet 2000; Buehler Ltd., Lake Bluff, IL, USA).
The roots were cut to a uniform length of 15 mm from the apical end. The apexes of
the teeth were sealed with a temporary filling material. Endodontic treatment was
performed following a standardized crown-down technique using rotary Ni–Ti
instruments of the K3 System (Sybron-Endo, Orange County, CA, USA). The apical
foramen was prepared to size 50. The following irrigation regimen was used. Before
a new instrument, the canal was filled with 2% chlorhexidine gel (CHX) (Natufarma,
Passo Fundo, RS, Brazil). After the use of each instrument, 5.0 mL distilled water
was used as an irrigating solution with a 5-mL syringe and a 30-G needle 3 mm
short of the working length. Final irrigation with 2 mL 17% EDTA for 3 min followed
by irrigation with 5 mL distilled water was performed to remove the smear layer.
Fig. 1. Specimens preparation for all groups defined by two study factors: amount of remaining root tooth tissue (2 or 1 mm of thick root) and post system (FB, fiber post;
FPC, fiber post relined with resin composite; CPC, cast Ni–Cr alloy post and core). Group 1, root intact; group 2, FB and 2 mm of thick root; group 3, FPC and 2 mm of thick
root; group 4, CPC and 2 mm of thick root; group 5, FB and 1 mm of thick root; group 6, FPC and 1 mm of thick root; and group 7, CPC and 1 mm of thick root.
2573
After that, all canals were dried with sterile paper points to conclude the protocol
(Souza et al., 2012). The root canals were filled with gutta-percha points and
Endofill (Dentsply Maillefer, Ballaigues, Switzerland) using the lateral condensation
technique and accessory gutta-percha points. After root canal filling, any excess
gutta-percha and sealer was removed, and coronal portion was sealed. The
specimens were immersed and kept in distilled water at 37 1C for a period of
1 week, corresponding to the root canal sealer setting time.
2.2. Specimens preparation
The teeth were divided into seven groups (n¼ 10), including the control group
with sound teeth, which received no treatment (intact teeth), and six experimental
groups defined by the two factors investigated: amount of remaining root tooth
tissue (2 or 1 mm of thick root) and post system (FB, fiber post; FPC, fiber post
relined with resin composite; CPC, cast Ni–Cr alloy post and core) (Fig. 1).
2.3. Intraradicular preparation
Two thirds of the root canal length was prepared, standardizing the post space
to 9.0 mm and preserving 5.0 mm of root filling at the apex. The root canal sealer
and core materials were removed from the root canals with heated instruments
and using size 3 Largo burs (Dentsply Maillefer) with a low-speed handpiece.
Additionally, the roots in this group were prepared with a spherical diamond bur
(no. 1014; KG Sorensen, Barueri, São Paulo, Brazil) that was initially used at slow-
speed to flare the root canal to a depth of 9 mm and another spherical diamond bur
(3017 HL; KG Sorensen) that was used for middle third flaring, reaching a depth of
5 mm. Final preparation was performed using size 4 Largo burs to a depth of 9 mm.
With the aid of a thickness meter, constant measurements were made until
dentinal walls with a thickness of 2 mm were obtained in thirty roots. The
thickness of the other thirty roots was 1 mm. CHX was the chemical auxiliary
used with the Largo burs for root canal preparation. Distilled water was the
irrigating solution used to remove CHX and the material originated from the
preparation of the root canal. Diamond bur was used with a slow speed diamond
and under copious distilled water spray.
2.4. Restorative procedures
2.4.1. Fiber post
After preparation, the root canals were cleaned with a 2% chlorhexidine and
dried. The dentin was etched with 37% phosphoric acid, and Adper Scotchbond
Multi-Purpose (3M ESPE, St Paul, MN) was applied according to the manufacturer's
recommendations and light polymerized for 40 s. The fiberglass posts (Angelus,
Londrina, PR, Brazil) with 1.1 mm of diameter were cleaned with alcohol, and
immediately after applying the adhesive system to the post, it was light polymer-
ized for 20 s on each side.
2.4.2. Fiber post relined with resin composite
Bonding procedures were realized to the root dentin similar to that of the
previous group. Afterward, the canal walls were lubricated with a hydrosoluble gel
(Natrosol; Drogal Pharmacy, Piracicaba, SP, Brazil). The fiber post was covered with
2574 R.R. Barcellos et al. / Journal of Biomechanics 46 (2013) 2572–2577
resin composite Z250 (B0.5, Z250, 3M ESPE) and inserted into the canal. After the
removal of the excess resin, the tip of the light-curing unit was placed over the
post, and the device was activated for 20 s. After composite resin polymerization,
the post was clamped with needle-nose pliers and removed from the canal. The
completion of the polymerization of the fiber post relining with resin composite
was performed outside the root canal for 40 s.
2.4.3. Cast post and core
Bonding procedures was realized to the root dentin similar to that of the
previous group. Root canal walls were lubricated, and Duralay resin (Reliance
Dental, Worth, IL, USA) was used to obtain molds of the intraradicular retainers by
the direct technique; prefabricated polycarbonate posts (Pin-jet, Angelus) were
used. The coronal portion of the acrylic pattern was 7.0 mm high and 4.0 mm in
diameter ( 7 0.2 mm). With the aid of a thickness meter, constant measurements
were made until the size was obtained in each specimen. For this preparation was
used drill FG283 (KG Sorensen). The patterns were invested cast in nickel–chrome
alloy (Ni–Cr alloy, Kromalit; Knebel, Porto Alegre, RS, Brazil).
2.5. Post luting procedures
After copious rinsing removal of the lubricant gel from the root canal in FPC
and CPC groups, the root canals were dried with absorbent paper points. One drop
of the bond of the Adper Scotchbond Multi-Purpose system was applied onto the
root canal surface, and the excess was removed with absorbent paper points and
light polymerized for 40 s. The dual-polymerizing resin luting material Rely X ARC
(3M ESPE) was mixed and injected into the prepared root canal with an appropriate
Centrix syringe (20 G) (DFL, Rio de Janeiro, RJ, Brazil) in all groups. Subsequently,
the intraradicular retainers were covered with cement and seated inside the
root canal and kept under finger pressure for 20 s; the excess cement was then
removed. The posts were cemented in centered position within the root canal. The
cement was light polymerized for 30 s on each surface (ie, buccal, palatal, mesial,
and distal), resulting in a 2-min light polymerization cycle.
2.6. Crown preparation and cyclic loading
To restore the coronal portion in fiber post and FPC groups, the incremental
technique was used to place composite resin Z250 (3M ESPE) around the posts
Fig. 2. Schematic representation of the fracture mode. (A) type 1, coronal fracture (displacement of the prosthetic set with fracture at the cementation line); (B) type 2,
transverse fracture in the cervical third of the root canal; (C) type 3, transverse fracture in the middle third of the root canal; (D) type 4, transverse fracture in the apical third
of the root canal; and, (E) type 5, vertical root fracture. (A and B) repairable fractures; (C, D and E) irreparable fractures.
to make filling cores. To standardize the size of the cores, an acetate matrix was
used to position the last layers. The matrix was made in a vacuum plasticizer from a
core model 7 mm high and 4 mm in diameter.
All specimens were finished with a diamond bur (no. 3216) at high speed
with water spray. Specimens were prepared to receive complete crowns with a
reduction of 1.5 mm and ferrule of 2.0 mm. Standardized crowns were obtained for
all teeth and cemented with Rely X ARC. Rectangular-shaped stops with a central
concavity were made on the palatine face of the patterns to locate and stabilize the
metal tip during cyclic loading.
The teeth were embedded in epoxy resin and condensation silicone to simulate
the artificial periodontal ligament, up to 2 mm short of the cervical portion, using a
circular metal matrix (25 mm in diameter # 20 mm high). The set (tooth, matrix,
and resin) remained immobile for 72 h to ensure resin setting. All specimens were
exposed to 250,000 cycles of mechanical fatigue in a controlled chewing simulator
(ER 11000 Plus, Erios, São Paulo, SP, Brazil). The force was applied 3 mm below the
incisal edge on the palatal surface of the crowns at a frequency of 2.6 Hz. A force of
30 N was chosen. The mechanical loading pattern was equivalent to 1 year of
clinical function (Stegaroiu et al., 1996). The force of 30 N mimicked previously
measured occlusal forces that occur during mastication and swallowing with
restored dentitions (Laurell and Lundgren, 1984).
2.7. Fracture resistance test
Next, the specimens were subjected to a compressive test in a universal testing
machine (Emic DL 2000, São José dos Pinhais, Brazil). The position of the specimens
was standardized using a device on the base of the apparatus, and load was applied
at an angle of 1351 in relation to the long axis of the roots (Cecchin et al., 2010;
Carlini-Júnior et al., 2013). An increasing oblique compressive load was applied on
the cingulum of the tooth′s palatal aspect (3 mm from the incisor edge), using
a cylindrical-shaped device with a round tip (2.7 mm in diameter). A cross-head
speed of 0.5 mm/min was applied until fracture. The maximum failure load was
recorded in Newtons (N).
The root-post fragment set was removed from the acrylic resin after fracture
and observed under a stereoscopic magnifying glass at # 20 magnification for
fracture analysis. Moreover, the fractured specimens were sputter coated with gold
in a Denton Vacuum Desk II Sputtering device (Denton Vacuum, Cherry Hill, NJ).
Thus, the fractured specimens were observed by scanning electron microscopy
(JSM-5600LV; JEOL Ltd, Tokyo, Japan) at 18 # magnification. The fractures were
 R.R. Barcellos et al. / Journal of Biomechanics 46 (2013) 2572–2577 2575

classified according to location as follows: (1) coronal fracture (displacement of the realized. Customizing the post increases its adaptation to the root
prosthetic set with fracture at the cementation line), (2) transverse fracture in the
walls and reduces the thickness of the resin cement (Grandini
cervical third of the root canal, (3) transverse fracture in the middle third of the
root canal, (4) transverse fracture in the apical third of the root canal, and et al., 2005). Closer contact between cement type and dentin is
(5) vertical fracture. Furthermore, failures were classified as follows: “a” repairable also important to improve the frictional retention of the post
when the fracture line was above the simulated bone level (types 1 and 2), and “b” (Goracci et al., 2005). Frictional retention is directly proportional
irreparable when the fracture line was below the simulated bone level (types 3, 4, to the contact area (the larger the contact surfaces, the better the
and 5) (Fig. 2).
Fracture resistance data were analyzed using two-way ANOVA, with three posts
retention) (Macedo et al., 2010). In addition, a higher post-to-root
systems and three levels of tooth remaining, followed by the Tukey′s honestly canal adaptation increases the sustained pressure during cemen-
significant difference (HSD) test. For all tests, a statistically significant difference tation. The application of sustained pressure results in better
was considered when α ¼0.05. contact between the cement/post assembly and the dentin and
reduces blister formation in the cement (Chieffi et al., 2007). This
may help explain the high values of fracture resistance in this
3. Results group, similar to the control group. According to Macedo et al.
(2010), it seems that the relining procedure increases the fiber
The means and standard deviations are presented in Table 1. post retention by improving the contact between the cement and
The statistical analysis of the data revealed significant differences the adhesive rather than by reducing the defects observed in thin
among the groups (P o0.05). Roots restored with FPC had the cement layers.
highest fracture strength of experimental groups, being statisti- However, the nonrelined fiberglass posts and cast posts had
cally similar to the intact teeth group (P 40.05). FP and CPC did similar fracture resistance and lowest that the fiber post relined
not differ statistically (P 40.05) and were statistically lowest than with resin composite. This is probably due to the mismatch
those of FPC (P o0.05). No statistically significant difference was between the diameters of the post space and the fiber post
observed between the amount of remaining root tooth tissue (2 or remains. Prefabricated posts do not fit well into elliptical-shaped
1 mm of thick root) and the same post systems (P 40.05). canals or flared canals that result from carious extension, trauma,
Table 2 shows the failure modes observed in each group. pulpal pathosis, or iatrogenic misadventure (D'Arcangelo et al.,
A prevalence of irreparable failures was observed in specimens 2007). In such cases, if the post does not fit well, the layer of resin
restored with CPC, whereas FP and FPC posts showed more cement might be excessively thick, favoring the formation of air
repairable failures (Fig. 2). bubbles and predisposing the post to debonding (Grandini et al.,
2005). Blisters can act as flaw-initiating sites during testing,
interfering with the fracture strength. The increase of resin cement
4. Discussion thickness may also increase the polymerization stress because
of the stress development increases associated with increased
In this study, restoring of teeth with fiber post relined with volume of the resin cement (Braga et al., 2006). One solution for
resin composite presented higher fracture resistance than teeth this issue is to reline the fiber post with resin composite as
restored with cast post and core and fiberglass posts. Therefore, demonstrated in this study. On the other hand, the low values of
the first hypothesis was supported by the results; the post system fracture resistance of the cast posts can be explained by their
influenced the fracture resistance of endodontically treated teeth. mechanical properties. This difference is probably because of the
In this group, relining the fiber post with resin composite was modulus of elasticity of the posts. Cast metal cores have a high
modulus of elasticity, and when they are subjected to occlusal
Table 1 forces, they produce forces against the root dentin walls, which
The Mean Fracture Resistance (N) and Standard Deviation (SD) for Each of the have a lower modulus of elasticity, thus increasing the possibility
7 Experimental Conditions.
of coronal-radicular fracture (Fokkinga et al., 2004; Nakamura
Groups Root condition Post type Mean 7 SD (N) et al., 2006; Zhou and Wang, 2013).
The minimum thickness of root dentine required around a post
Group 1 Intact No 402.25 (106.85)a is uncertain, and values from 1.0 to 1.75 mm are often suggested
Group 2 2 mm FP 260.23 (69.74)b
(Lloyd and Palik, 1993). Root canal treatment might result in larger
Group 3 2 mm FPC 431.29 (83.07)a
Group 4 2 mm CPC 241.35 (68.27)b root canals and thinner surrounding dentine walls (Marchi et al.,
Group 5 1 mm FP 263.69 (91.87)b 2008). In the present study, standardized canal preparations were
Group 6 1 mm FPC 380.97 (75.84)a performed to 1- and 2-mm remaining root dentine thickness. The
Group 7 1 mm CPC 262.44 (95.17)b results of our study showed no significant difference on fracture
FB, fiber post; FPC, fiber post relined with resin composite; CPC, cast post and core.
resistance between the amounts of remaining root dentine. There-
Means followed by the same letters are not statistically different (ANOVA/Tukey fore, the second hypothesis was rejected. These results are not
test, α ¼ 5%). according to Marchi et al. (2008). According to these authors, the
intact roots had significantly higher values compared with the
weakened ones. However, in the study of Marchi et al. (2008), the
Table 2 weakened roots showed thickness of 0.5 mm in the cervical
Failure mode distribution in experimental groups (n¼ 10).
region. In our study, the less thicker roots had 1 mm.
Groups Failure mode distribution The distribution of the fracture mode is an extremely important
parameter for comparative analysis between post systems (Fig. 2).
Type 1 Type 2 Type 3 Type 4 Type 5 Repairable Irreparable Fiberglass posts relined or nonrelined with composite resin had
significantly more repairable fractures than cast posts and cores. It
1 5 5 – – – 10 –
2 7 1 1 1 7 3 is known that the stress distribution in root-filled tooth restored
3 – 10 – – – 10 – with posts is influenced by the characteristics of the constituent
4 – 4 1 – 5 4 6 material of the posts. Coelho et al., 2009 showed the similarity
5 – 8 2 – – 8 2 between the elastic modulus the dentin (15–25 GPa), fiberglass
6 – 6 3 1 1 5 4
7 – – 2 – 8 – 10
posts (30–40 GPa), and composite resin (20 GPa) (Coelho et al.,
2009). A material with an elastic modulus similar to dentine, such
2576 R.R. Barcellos et al. / Journal of Biomechanics 46 (2013) 2572–2577
as fiber posts and composite resin, accompanies the natural
flexural movements of the tooth (Lassila et al., 2004; Asmussen
et al., 2005; Nakamura et al., 2006; Santos-Filho et al., 2008). This
property reduces stress concentrations at the interfaces, enabling
the complex restoration to mimic the biomechanical behavior of
sound teeth (Santos-Filho et al., 2008) and minimizing irreparable
fractures (Ferrari et al., 2000; Santos-Filho et al., 2008; Santana
et al., 2011). The group restored with cast post and core showed a
higher number of irreparable failure, particularly where the root
thickness was 1 mm that resulted in irreparable failures in all
samples. Therefore, the conservation of healthy tooth structure is
an important factor in the restoration of endodontically treated
teeth. When a post system with a high modulus of elasticity as cast
posts and core (NiCr—200 GPa) is loaded (Coelho et al., 2009),
a slowly growing crack causes a successive adhesive failure of the
post–cement–root dentin interface. After loss of post adhesion, the
post is more or less mobile within the root and is consequently
allowed to act like a wedge. The energy accumulated in the inner
post is transferred by the dentin causing root fracture (Coelho
et al., 2009; da Silva et al., 2010).
When restoring root-filled teeth, clinicians are opting for
materials that are capable of creating homogenous stress distribu-
tion and are able to decrease the incidence of irreparable root
fractures (Ferrari et al., 2000; Bitter et al., 2009). Therefore, an
important advance in restoring endodontically treated teeth has
been the introduction of fiber posts, beside the development
of effective adhesive composite cements (Schwartz and Robbins
2004; Al-Omiri et al., 2010). Furthermore, studies showed that the
fiber posts do not need to be inserted to a length equal to or longer
than the depth of the clinical crown to increase the root fracture
resistance. This is advantageous for short roots or for roots
presenting a high degree of curvature. Thereby, a high in-depth
insertion into the root canal is not necessary to improve retention
(Santos-Filho et al., 2008; Cecchin et al., 2010; Borelli et al., 2012;
Ramírez-Sebastià et al., in press). Our study showed that fiberglass
posts exhibit fracture resistance similar to the cast post and core.
These results are in agreement with previous studies (da Silva
et al., 2010; Santana et al., 2011; Castro et al., 2012). Moreover, the
use of fiberglass posts relined with composite resin showed the
best results of this study and seemed to be an effective method to
improve fracture resistance and reduce irreparable failures
on endodontically treated teeth. Despite good results with this
retainer intraradical, additional clinical studies are necessary to
determine the best techniques and materials to closely mimic
tooth structures and to recover the mechanical properties and
resistance to fracture of structurally compromised teeth.
5. Conclusion
Roots restored with fiber post relined with resin composite had
higher fracture resistance, followed by fiber posts and cast post
and core that showed similar values. The mode of fracture was
more restorable with fiberglass posts and fiber post relined with
resin composite; on the other hand, cast post and core showed
more nonrestorable fracture mode. The remaining dentine with
2- or 1-mm thickness was not an important factor for the fracture
resistance in this study; however, for the group with thickness of
1 mm and cast post and core, restoration had resulted in irrepar-
able failures in all the samples.
Acknowledgments
The authors disavow any financial affiliations related to this
study or its sponsors. The study was supported by research grants
from the University of Passo Fundo (PIVIC-UPF) No. 2012/34530.
We are thanking Angelus for the donation of fiber post.
Conflict of interest statement
The authors had no conflict of interesting working on or
writing this article.
References
Al-Omiri, M.K., Mahmoud, A.A., Rayyan, M.R., Abu-Hammad, O., 2010. Fracture
resistance of teeth restored with post-retained restorations: an overview.
Journal of Endodontics 36, 1439–1449.
Asmussen, E., Peutzfeldt, A., Sahafi, A., 2005. Finite element analysis of stresses in
endodontically treated, dowel-restored teeth. Journal of Prosthetic Dentistry
94, 321–329.
Bacchi, A., Dos Santos, M.B., Pimentel, M.J., Caetano, C.R., Sinhoreti, M.A., Consani, R.
L., 2013. Influence of post-thickness and material on the fracture strength of
teeth with reduced coronal structure. Journal of Conservative Dentistry 16,
139–143.
Belli, S., Erdemir, A., Ozcopur, M., Eskitascioglu, G., 2005. The effect of fiber
insertion on fracture resistance of root filled molar teeth with MOD prepara-
tions restored with composite. International Endodontic Journal 38, 73–80.
Bitter, K., Noetzel, J., Stamm, O., Vaudt, J., Meyer-Lueckel, H., Neumann, K.,
Kielbassa, A.M., 2009. Randomized clinical trial comparing the effects of post
placement on failure rate of postendodontic restorations: preliminary results of
a mean period of 32 months. Journal of Endodontics 35, 1477–1482.
Borelli, B., Sorrentino, R., Zarone, F., Ferrari, M., 2012. Effect of the length of glass
fiber posts on the fracture resistance of restored maxillary central incisors.
American Journal of Dentistry 25, 79–83.
Braga, R.R., Boaro, L.C., Kuroe, T., Azevedo, C.L., Singer, J.M., 2006. Influence of cavity
dimensions and their derivates (volume and ‘C’ factor) on shrinkage stress
development and microleakage of composite restorations. Dental Materials 22,
818–823.
Carlini-Júnior, B., Cecchin, D., Farina, A.P., Pereira, G.D., Prieto, L.T., Paulillo, L.A.,
2013. Influence of remaining coronal structure and of the marginal design on
the fracture strength of roots restored with cast post and core. Acta Odonto-
logica Scandinavica 71, 278–282.
Castro, C.G., Santana, F.R., Roscoe, M.G., Simamoto Jr, P.C., Santos-Filho, P.C., Soares, C.J.,
2012. Fracture resistance and mode of failure of various types of root filled teeth.
International Endodontic Journal 45, 840–847.
Cecchin, D., Farina, A.P., Guerreiro, C.A.M., Carlini-Júnior, B., 2010. Fracture resis-
tance of roots prosthetically restored with intraradicular posts of different
lengths. Journal of Oral Rehabilitation 37, 116–122.
Chieffi, N., Chersoni, S., Papacchini, F., Vano, M., Goracci, C., Davidson, C.L., Tay, F.R.,
Ferrari, M., 2007. The effect of application sustained seating pressure on
adhesive luting procedure. Dental Materials 23, 159–164.
Coelho, C.S., Biffi, J.C., Silva, G.R., Abrahão, A., Campos, R.E., Soares, C.J., 2009. Finite
element analysis of weakened roots restored with composite resin and posts.
Dental Materials Journal 28, 671–678.
D'Arcangelo, C., De Angelis, F., Vadini, M., Zazzeroni, S., Ciampoli, C., D′Amario, M.,
2008. In vitro fracture resistance and deflection of pulpless teeth restored with
fiber posts and prepared for veneers. Journal of Endodontics 34, 838–841.
da Silva, N.R., Raposo, L.H., Versluis, A., Fernandes-Neto, A.J., Soares, C.J., 2010. The
effect of post, core, crown type, and ferrule presence on the biomechanical
behavior of endodontically treated bovine anterior teeth. Journal of Prosthetic
Dentistry 104, 306–317.
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 International 39, 117–129.
Farina, A.P., Cecchin, D., Garcia, L., da, F., Naves, L.Z., Sobrinho, L.C., Pires-de-Souza, F.,
de, C., 2011. Bond strength of fiber posts in different root thirds using resin cement.
Journal of Adhesive Dentistry 13, 179–186.
Ferrari, M., Vichi, A., Garcia-Godoy, F., 2000. Clinical evaluation of fiber reinforced
epoxy resin posts and cast post and cores. American Journal of Dentistry 13,
15B–18B.
Fokkinga, W.A., Kreulen, C.M., Le Bell-Rönnlöf, A.M., Lassila, L.V., Vallittu, P.K.,
Creugers, N.H., 2006. In vitro fracture behavior of maxillary premolars with
metal crowns and several post-and-core systems. European Journal of Oral
Sciences 114, 250–256.
Fokkinga, W.A., Kreulen, C.M., Vallittu, P.K., Creugers, N.H., 2004. A structured
analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic
post-and-core systems. International Journal of Prosthodontics 17, 476–482.
Goracci, C., Fabianelli, A., Sadek, F.T., Papacchini, F., Tay, F.R., Ferrari, M., 2005. The
contribution of friction to the dislocation resistance of bonded fiber posts.
Journal of Endodontics 31, 608–612.
Grandini, S., Goracci, C., Monticelli, F., Borracchini, A., Ferrari, M., 2005. SEM
evaluation of the cement layer thickness after luting two different posts.
Journal of Adhesive Dentistry 7, 235–240.
 R.R. Barcellos et al. / Journal of Biomechanics 46 (2013) 2572–2577
Iglesia-Puig, M.A., Arellano-Cabornero, A., 2004. Fiber-reinforced post and core
adapted to a previous metal ceramic crown. Journal of Prosthetic Dentistry 91,
191–194.
Lassila, L.V.J., Tanner, J., Le-Beel, A.M., Narva, K., Vallittu, P.K., 2004. Flexural
properties of fiber reinforced root canal posts. Dental Materials Journal 20,
29–36.
Laurell, L., Lundgren, D., 1984. A standardized programme for studying the occlusal
force pattern during chewing and biting in prosthetically restored dentitions.
Journal of Oral Rehabilitation 11, 39–44.
Lloyd, P.M., Palik, J.F., 1993. The philosophies of dowel diameter preparation: a
literature review. Journal of Prosthetic Dentistry 69, 32–36.
Macedo, V.C., Faria e Silva, A.L., Martins, L.R., 2010. Effect of cement type, relining
procedure, and length of cementation on pull-out bond strength of fiber posts.
Journal of Endodontics 36, 1543–1546.
Maceri, F., Martignoni, M., Vairo, G., 2007. Mechanical behaviour of endodontic
restorations with multiple prefabricated posts: a finite-element approach.
Journal of Biomechanics 40, 2386–2398.
Marchi, G.M., Mitsui, F.H., Cavalcanti, A.N., 2008. Effect of remaining dentine
structure and thermal-mechanical aging on the fracture resistance of bovine
roots with different post and core systems. International Endodontic Journal 41,
969–976.
Nakamura, T., Ohyama, T., Waki, T., Kinuta, S., Wakabayashi, K., Mutobe, Y., Takano, N.,
Yatani, H., 2006. Stress analysis of endodontically treated anterior teeth restored
with different types of post material. Dental Materials Journal 25, 145–150.
Ng, C.C., Dumbrigue, H.B., Al-Bayat, M.I., Griggs, J.A., Wakefield, C.W., 2006.
Influence of remaining coronal tooth structure location on the fracture
resistance of restored endodontically treated anterior teeth. Journal of Pros-
thetic Dentistry 95, 290–296.
Qualtrough, A.J.E., Mannocci, F., 2003. Tooth-colored post systems: a review.
Operative Dentistry 28, 86–91.
2577
Ramírez-Sebastià, A., Bortolotto, T., Cattani-Lorente, M., Giner, L., Roig, M., Krejci, I.,
2013. Adhesive restoration of anterior endodontically treated teeth: influence
of post length on fracture strength. Clinical Oral Investigation. (in press) 10.1007/
s00784-013-0978-3.
Santana, F.R., Castro, C.G., Simamoto-Júnior, P.C., Soares, P.V., Quagliatto, P.S., Estrela, C.,
Soares, C.J., 2011. Influence of post system and remaining coronal tooth tissue on
biomechanical behaviour of root filled molar teeth. International Endodontic
Journal 44, 386–394.
Santos-Filho, P.C., Castro, C.G., Silva, G.R., Campos, R.E., Soares, C.J., 2008. Effects of
post system and length on the strain and fracture resistance of root filled
bovine teeth. International Endodontic Journal 41, 493–501.
Schwartz, R.S., Robbins, J.W., 2004. Post placement and restoration of endodonti-
cally treated teeth: a literature review. Journal of Endodontics 30, 289–301.
Soares, C.J., Soares, P.V., de Freitas Santos-Filho, P.C., Castro, C.G., Magalhaes, D.,
Versluis, A., 2008. The influence of cavity design and glass fiber posts on
biomechanical behavior of endodontically treated premolars. Journal of Endo-
dontics 34, 1015–1019.
Souza, M., Cecchin, D., Farina, A.P., Leite, C.E., Cruz, F.F., Ferraz, C.C., Figueiredo, J.A.,
2012. Evaluation of chlorhexidine substantivity on human dentin: a chemical
analysis. Journal of Endodontics 38, 1249–1252.
Stegaroiu, R., Yamada, H., Kusakari, H., Miyakawa, O., 1996. Retention and failure
mode after cyclic loading in two post and core systems. Journal of Prosthetic
Dentistry 75, 506–511.
Trope, M., Maltz, D.O., Tronstad, L., 1985. Resistance to fracture of restored
endodontically-treated teeth. Endodontics & Dental Traumatology 1, 108–111.
Zhou, L., Wang, Q., 2013. Comparison of fracture resistance between cast posts and
fiber posts: a meta-analysis of literature. Journal of Endodontics 39, 11–15.
Zicari, F., Van Meerbeek, B., Scotti, R., Naert, I., 2013. Effect of ferrule and post
placement on fracture resistance of endodontically treated teeth after fatigue
loading. Journal of Dentistry 41, 207–215.