RESEARCH AND EDUCATION

In vitro retention of prefabricated and individually formed

posts: A pilot study
Ivana Par!cina Ami!zi"c, DMD, PhD,a Ivana Mileti"c, DDS, PhD,b Anja Baraba, DDS, PhD,c Yuwei Fan, PhD,d and
Dan Nathanson, DMD, MSDe

Prefabricated esthetic fiber- ABSTRACT

reinforced composite (FRC)
posts have become popular for
the restoration of endodonti-
cally treated teeth.1 The main
advantages of FRC posts over
metal posts include improved
restoration esthetics, adhesive
bonding to tooth structure,
and an elastic modulus closer
to that of dentin. The similar
elastic modulus provides ho-
mogeneous stress distribution
in the canal2 and a lower risk
of root fracture3 with favorable
biomechanical properties. 4
Statement of problem. Data on the retention of individually formed fiber-reinforced composite
posts (everStick) cemented with self-adhesive cement are lacking.
Purpose. The purpose of this in vitro study was to investigate the pull-out strength of 2 different
fiber-reinforced composite posts (prefabricated and individually formed) cemented into extracted
teeth with self-adhesive resin cement.
Material and methods. Thirty extracted single-rooted human teeth were decoronated,
endodontically treated, and prepared with post spaces of equal length. Prepared specimens
were divided into 2 groups (n=15 each) based on the type of post: commercially prefabricated
fiber posts (GC) and individually formed resin posts (using GC reinforcing fibers). Self-adhesive
resin cement (G-CEM LinkAce; GC) was used to cement all posts. Each post was held with
moderate pressure, and root surfaces were light polymerized for 20 seconds (650 mW/cm2).
After cementation, the specimens were stored in saline solution for 30 days. Treated teeth were
kept in water for 24 hours before pull-out testing parallel to the longitudinal axis of the posts.
Data were analyzed using the Student t test (a=.05) and the coefficient of variance as the ratio
of the standard deviation to the mean.

Although resin-based ma- Results. The mean pull-out retention strength was 185.7 ±61.2 N for the prefabricated fiber posts
terials for prefabricated FRC and 98.9 ±56.5 N for the individually formed fiber posts (P=.026).
posts are compatible with ad- Conclusions. The prefabricated fiber posts exhibited significantly higher retention forces than the
hesive restorative techniques, individually formed posts. (J Prosthet Dent 2018;-:---)
their highly cross-linked struc-
ture and high degree of conversion do not allow the parts, weakening the tooth root. Furthermore, 25% of
monomers of composite resin luting cements to pene- tooth roots have elliptical canals,7 so prefabricated
trate and achieve chemical bonding. Thus, to improve
5
posts with a circular cross section do not fully fit in
this interaction, the fiber posts must be surface treated those canals. Lack of fit could jeopardize bonding and
with a silane coupling agent.6 The root canal dimensions the long-term clinical success of a tooth restored with
should be adjusted to the predefined size of the posts an FRC post.
by using the corresponding drill, but this can some- To avoid preparing the root canal and to enhance the
times require considerable dentin removal in the apical adhesion between polymer-based materials and luting

Supported by a grant “Influence of different pretreatments of hard dental tissues on bond strength of dental materials” from the University of Zagreb, Croatia, in 2016.
a
Postdoctoral researcher, Department of Dental Medicine, Health Center for County of Dalmatia, Split, Croatia.
b
Professor, Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
c
Assistant Professor, Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia.
d
Assistant Professor, Department of Restorative Sciences & Biomaterials, Boston University Goldman School of Dental Medicine, Boston, Mass.
e
Professor, Department of Restorative Sciences & Biomaterials, Boston University Goldman School of Dental Medicine, Boston, Mass.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

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Clinical Implications
Although fiber-reinforced composite posts that can
be polymerized in situ in the root canal are gaining
popularity, clinicians should be cautious because
these posts exhibit significantly lower retention
in vitro than commercially available prefabricated
fiber posts.

cements, a new type of post that can be polymerized in

situ in the root canal has been introduced.8 These posts
are formed in the dental office and are made of unidi-
rectional, silanated E-glass fibers impregnated with a
Figure 1. GC Fiber Post.
combination of polymethyl methacrylate as a linear
phase and bisphenol A-glycidyl methacrylate as the
curettes and brushes. The specimens were then placed in
cross-linked phase, which together form a semi-
0.9% saline solution at room temperature.
interpenetrating polymer network (semi-IPN).8 Because
The coronal part of each tooth above the cemento-
of the unpolymerized semi-IPN, the monomers of ad-
enamel junction was removed with a diamond rotary
hesive resins and cements can diffuse into the poly-
instrument under constant water cooling, leaving roots of
methyl methacrylate, and by polymerization, they form
14 mm in length. All specimens were endodontically
interdiffusion bonding and so-called secondary semi-IPN
treated using a file (RECIPROC R40; VDW GmbH) ac-
structure.9 With individually formed IPN posts, it is not
cording to the manufacturer’s instruction. After instru-
necessary to adjust the root canal to the shape of the
mentation, the canals were irrigated with 2 mL of 17%
post. Rather, the post is adapted to the morphology of
ethylenediaminetetraacetic acid (pH 7.7) for 1 minute to
the root canal, and in the case of very large coronal
remove the smear layer. Final irrigation was completed
openings, additional material can be easily added. Ac-
using 2 mL of 0.9% saline solution. The root canals were
cording to the manufacturer, the risk of perforation is
dried using #40 paper points (RECIPROC Paper Points;
reduced, stress in the apical parts of the root canal is
VDW GmbH) and then obturated with #40 gutta percha
minimized, and adhesive surface is maximized. There-
points (RECIPROC Gutta-Percha; VDW GmbH) and
fore, it could be assumed that this kind of structure has
sealer (AH Plus; Dentsply Sirona) by a single-cone
fewer or no voids. It has already been suggested that an
technique. Excess gutta percha was removed 1 mm
absence of voids at the fiber posteresin cement interface
from the cemento-enamel junction with a heated
indicated a good bond between the post surface and
plugger, and the coronal root canal openings were filled
resin cement.10
with interim restorative material (GC Fuji IX GP Cap-
Because glass-fiber posts are gaining popularity over
sules; GC). The specimens were stored in 100% humidity
metal posts and there is a lack of data, the purpose of this
for 1 week at room temperature to allow the sealer to
in vitro study was to compare the retention strength
polymerize.
between prefabricated and individually formed fiber
In both the experimental groups, a 9-mm-deep post
posts cemented with self-adhesive cement by using the
space was prepared using a #4 Gates Glidden drill
pull-out test. The null hypothesis was that the type of
(G180.204.110; Komet, Gebr, Brasseler GmbH). The
FRC post (prefabricated or office fabricated) does not
length of the post space was verified using an end-
affect the retentive strength to root dentin.
odontic hand instrument, (#25-size K-reamer). After
post space preparations, all specimens were divided into
MATERIAL AND METHODS
2 groups (n=15) according to the type of FRC post:
The study protocol was reviewed and approved by the prefabricated fiber post (GC Fiber Post; GC) (Fig. 1) and
Ethics Committee of the School of Dental Medicine, individually formed fiber post (everStick POST; GC)
University of Zagreb. Intact straight single-rooted human (Fig. 2). For the prefabricated fiber post group, the post
maxillary premolars were obtained from the Department space was additionally prepared using a fiber post drill
for Oral Surgery, School of Dental Medicine, University (color code: red). The 1.2-mm-wide prefabricated fiber
of Zagreb. The teeth were extracted for periodontal rea- post was coated with primer (Ceramic Primer; GC)
sons. Teeth with similar root diameters and lengths prepared by mixing 1 drop of liquid from bottle A and
(N=30) were selected for the study. Dental plaque, cal- bottle B for 5 seconds. The post surface was then air-
culus, and periodontal tissues were removed with dried for 5 seconds. For the individually formed fiber

THE JOURNAL OF PROSTHETIC DENTISTRY Ami!zic

" et al
- 2018 3

Figure 2. everStick POST. A, As supplied in package. B, Individually formed according to post space preparation.

post group, each post size, 1.2 mm in diameter, was

adjusted to the root canal using tweezers; after adjust-
ment, the post was protected from light by placing it
under a light shield.
In both the groups, the root canals were rinsed with
5 mL of 0.9% saline solution, after which they were dried
using RECIPROC Paper Points of size #40. Both the post
systems were cemented with the same self-adhesive
cement (G-CEM LinkAce; GC). The cement was
extruded into each canal through a syringe with a special
tip for mixing the 2 cement components. Each post was
then positioned into the post space. Each FRC post was
held in place with moderate pressure, and the surfaces
were light polymerized for 20 seconds using a light-
emitting diode light polymerizing unit (Bluephase;
Ivoclar Vivadent AG) at low power with an intensity of
650 mW/cm2. After cementation, the specimens were
stored in saline solution for 30 days.
The retention test was carried out using a modified
technique11 that is used for the pull-out test. The exposed
end of each post was coated with bonding agent
(Scotchbond Universal; 3M ESPE) and fixed in a hexag- Figure 3. Pull-out test.
onal steel coupling nut filled with composite resin
(Z-250; 3M ESPE), leaving a gap of about 3 mm between
the root surface and the retention coupling. The com- RESULTS
posite resin was light polymerized for 20 seconds around
None of the specimens failed during testing, and all the
the nut filled with composite resin. The alignment of the
posts pulled cleanly out of the canals. Mean values,
testing apparatus was visually approximated to the lon-
standard deviations, and coefficient of variation for both
gitudinal axis of the post. Treated teeth were kept in
the post systems are presented in Table 1. The pull-out
water for 24 hours before pull-out testing. Each specimen
retention forces were significantly affected by the type
was subjected to a tensile force parallel to the longitudinal
of FRC post (P=.026). The analysis showed that the
axis of the posts (Instron; x-head speed, 0.5 mm/min)
prefabricated fiber post yielded significantly higher
until post separation (Fig. 3). The pull-out force (N) was
retention values than the individually formed posts.
recorded for each specimen.
Statistical analysis was performed using statistical
DISCUSSION
software (JMP Pro 11.0; SAS Institute Inc). Data were
analyzed using the Student t test (a=.05) and the coef- The null hypothesis was rejected because retentive
ficient of variance as the ratio of the standard deviation to strength was significantly affected by the type of post. To
the mean. evaluate the retention of the 2 different fiber posts

Ami!zic
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4 Volume
Table 1. Mean values, standard deviations, and coefficients of variance
for pull-out strength for each FRC post system
Mean Separation Force
Post System N (Newtons) ±SD
everStick POST 15 98.9 ±56.5
GC Fiber Post 15 185.7 ±61.2
CV, coefficient of variance; FRC, fiber-reinforced composite; SD, standard deviation.
cemented with self-adhesive cement, the present study
used the pull-out test. Nova et al12 emphasized that the
clinical relevance of the pull-out test is because de-
bonding is the most usual failure mode of FRC posts13
and that axial loading is considered predominant with
clinical restorations.14
According to the results of the present research, the
prefabricated fiber post appeared to be more retentive to
root dentin than the individually made (everStick) posts.
During the post preparation, the prefabricated posts were
treated with silane coupling agent. This pretreatment
significantly improved the push-out bond strength be-
tween the post and cement, especially when the posts
were cemented with self-adhesive cement.15 In this
study, the everStick posts were polymerized with self-
adhesive cement, without being previously treated with
light-polymerized adhesive. This decision was influenced
not only by the instructions of the manufacturer but also
by the results of the study by Makarewicz et al.16
Nevertheless, a few previous investigations17,18 applied
light-polymerized adhesive to the surface of everStick
posts and reported high bond strength values in com-
parison with other types of posts. Sipahi et al19 even
found surface treatments with hydrofluoric acid, silica
coating, and Er:YAG laser irradiation to be effective
methods for improving the bonding of everStick posts to
resin cement. Al-Tayyan et al20 compared the retention
of a flexible, directly placed fiber-bundle dowel system
(everStick) after adhesive treatment with that of a rigid
prefabricated FRC dowel system and found no significant
difference between the 2 tested types of posts. However,
the mean axial resistance forces (standard deviation) for
all groups20 were similar to those achieved in the pre-
fabricated fiber post group in the present research. It
follows that the lack of pretreatment in the present study
might also have affected the low retention values of
everStick individual posts. Another reason for the dif-
ference in retention between the 2 groups tested in this
study could be the difference of procedures between the
2 groups. Prefabricated posts are rigid and may have
been much easier to place and cement, whereas the
everStick group required more attention in fabricating the
posts and more delicate handling in fitting the posts into
the prepared root canals.
Regarding the retention values of the tested pre-
fabricated fiber post, previous studies with similar
methodology also presented comparable results. Kelsey
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
et al21 evaluated the effect of 2 surface treatments on the
retention of 3 types of dowels, 2 of which were pre-
fabricated fiber posts placed into prepared canals with a
CV
57.2
total-etch resin cement. Although fiber dowels that are
32.9
not roughened demonstrated significantly less retention
than those in all other test groups, surface conditioning
involving silane treatment and surface roughening led to
better bonding of the FRC posts. After treatment, it was
found that mean tensile loads and standard deviations
(N) for debonding21 were similar to the values scored by
prefabricated fiber posts in the present study, in which
only silanization was applied. Aleisa et al22 evaluated the
retention of fiber posts cemented with 3 different types of
cement, including self-adhesive cement, after 24 hours
and 2 weeks. At 24 hours and 2 weeks, fiber posts luted
with self-adhesive cement exhibited higher retention
than those luted with other types of cement.22 Still, forces
required for post dislodgment were lower than forces
required for pulling out the prefabricated fiber post in the
present research. This is not surprising because Aleisa
et al prepared post spaces to a depth of 8 mm, and after
cementation, they stored specimens for 24 hours and 2
weeks,22 unlike the 9-mm-deep post space and 30 days
of storage applied in the present study.
The present study was designed to compare the pull-
out performance of prefabricated fiber posts and indi-
vidually formed IPN posts after short-term 30-day water
storage. The results derived from this study apply only to
the conditions under which this research was carried out,
and the primary task was to establish basic guidelines for
further exploration.
Good bonding between FRC posts and composite
resin cement is of great importance in the restoration of
endodontically treated teeth and should be further
investigated using methodology that includes different
self-adhesive cements and long-term storage conditions.
The results of such research should also determine the
interface at which the resin bond failed. New studies
need to be conducted to simulate masticatory forces from
different directions and investigate retention of the
complete restorations of endodontically treated teeth.
CONCLUSIONS
Based on the findings of this in vitro study, the following
conclusion was drawn:
1. Prefabricated fiber posts exhibited significantly
higher retention forces than individually fabricated
fiber posts.
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Corresponding author:
Dr Anja Baraba
Department of Endodontics and Restorative Dentistry
School of Dental Medicine
University of Zagreb
Gunduli"ceva 5
10000 Zagreb
CROATIA
Email: baraba@sfzg.hr
Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
THE JOURNAL OF PROSTHETIC DENTISTRY