Mechanical behaviour of endodontic restorations with multiple prefabricated posts: A finite-element approach

The Effect of Remaining Coronal Tissue Height on the Fracture Strength of Over-Flared Endodontically Treated Central Incisors Restored Using a Multipost Approach

Objectives

This study aimed to examine the effect of remaining coronal tissue height on the fracture strength of over-flared endodontically treated central incisors restored with multiple prefabricated fiberglass posts using the multipost approach.

Materials and Methods

A total of 40 human central maxillary incisors were examined in this study. The samples were assigned to five groups (n = 8) based on the height of the remaining coronal tissue: with no remaining coronal tissue, 1-mm coronal tissue height (CTH1), 2-mm coronal tissue height, 3-mm coronal tissue height (CTH3), and one intact tooth (IT) group. Following endodontic treatment of an over-flared canal, the postspace depth was 10 mm, and the residual dentin thickness was 1 mm. Two prefabricated fiberglass posts were cemented into the root canal, adopting a multipost approach. The static load was applied at 0.5 mm/min and 135° concerning the tooth's longitudinal axis until a fracture occurred. One-way analysis of variance and the post hoc Tukey's test were performed to analyze the data at a significance level of p < 0.05.

Results

The maximum fracture strength was recorded for IT (control group), while the minimum fracture strength was found for teeth with a coronal tissue height of 1 mm. The differences between IT group and other groups (p < 0.05), as well as the differences between the group with CTH3 and groups without coronal tissue and CTH1, were significant.

Conclusion

In sum, an increase in the height of the remaining coronal tissue (≥3 mm) significantly increased the fracture strength of over-flared endodontically treated central incisors after restoration with prefabricated fiberglass posts by adopting a multipost approach.

Finite element analysis of maxillary first molar with mesial-occlusal-distal-palatal defect restored with different post-and-core strategies

Purpose

To explore which restoration strategy generates the most favorable stress distribution in an endodontically-treated maxillary first molar with mesial-occlusal-distal-palatal defect.

Methods

Models with one post in palatal canal (PP), each post in palatal and distobuccal canals (PDP), each post in palatal and mesiobuccal canals (PMP), and each post in all canals (PDMP) were established for an endodontically-treated maxillary first molar with mesial-occlusal-distal-palatal defect either with fiber-reinforced composite (FRC) post or gold alloy cast (GAC) post. A 400-N vertical force and a 225-N lateral force were respectively applied. The Mohr-Coulomb stress ratio (σ_{MC ratio}) in the residual tooth structure (RTS), the resin cement, and the crowns, the tensile stress (σ_t) and compressive stress (σ_c) in the FRC posts, the von-Mises stress ratio (σ_{vM ratio}) in the GAC post-and-cores, and the σ_t and shear stress (σ_s) at the adhesive interfaces were calculated using finite element analysis.

Results

FRC posts generated lower σ_{MC ratio} than GAC posts in the RTS (0.3274-0.3643 vs. 0.3399-0.4118). Among the FRC post groups, the PDMP group got the lowest σ_s at the dentin-post interface (14.92 MPa) and the abutment-crown interface (8.242 MPa) under vertical loading, as well as the lowest σ_{MC ratio} in the RTS (0.3381) and the lowest σ_s at the dentin-post interface (38.00 MPa) under lateral loading.

Conclusions

From the point of stress distribution, placing FRC posts in the palatal, distobuccal, and mesiobuccal canals is the optimal strategy in restoring a severely damaged maxillary first molar, provided that lateral occlusal force is reduced.

Biomechanical Modelling for Tooth Survival Studies: Mechanical Properties, Loads and Boundary Conditions-A Narrative Review

Recent biomechanical studies have focused on studying the response of teeth before and after different treatments under functional and parafunctional loads. These studies often involve experimental and/or finite element analysis (FEA). Current loading and boundary conditions may not entirely represent the real condition of the tooth in clinical situations. The importance of homogenizing both sample characterization and boundary conditions definition for future dental biomechanical studies is highlighted. The mechanical properties of dental structural tissues are presented, along with the effect of functional and parafunctional loads and other environmental and biological parameters that may influence tooth survival. A range of values for Young's modulus, Poisson ratio, compressive strength, threshold stress intensity factor and fracture toughness are provided for enamel and dentin; as well as Young's modulus and Poisson ratio for the PDL, trabecular and cortical bone. Angles, loading magnitude and frequency are provided for functional and parafunctional loads. The environmental and physiological conditions (age, gender, tooth, humidity, etc.), that may influence tooth survival are also discussed. Oversimplifications of biomechanical models could end up in results that divert from the natural behavior of teeth. Experimental validation models with close-to-reality boundary conditions should be developed to compare the validity of simplified models.

Effects of composite resin core level and periodontal pocket depth on crack propagation in endodontically treated teeth: An extended finite element method study

STATEMENT OF PROBLEM

Preserving teeth with radicular cracks with or without a periodontal pocket is an alternative to extraction. However, an effective protocol for the restoration of radicular cracks is lacking.

PURPOSE

The purpose of this study was to examine the composite resin core level and periodontal pocket depth effects on stress distribution, maximum von Mises stress, and crack propagation in endodontically treated teeth by using the extended finite element (FE) method.

MATERIAL AND METHODS

Four 3-dimensional models of a cracked endodontically treated mandibular first molar were constructed: PP2C2 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the canal orifice level); PP2C4 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the crack level); PP4C2 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the canal orifice level); and PP4C4 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the crack level). The crack initiation was at the same level in all models. A static 700-N load was applied to the models in a vertical direction.

RESULTS

The highest stress in dentin was observed in PP2C2, whereas PP2C4 exhibited the lowest stress and least crack propagation. Stress was high in the dentin and supporting bone. No reduction in crack propagation was observed in the PP4 models, regardless of the composite resin core level.

CONCLUSIONS

The periodontal pocket depth (2 mm and 4 mm) and composite resin core level (2 mm below the crack level and 2 mm below the canal orifice level) affected stress concentration in dentin, resulting in different patterns of crack propagation in the FE models.

FINITE ELEMENT EVALUATION OF THE EFFECT OF ADHESIVE CREAMS ON THE STRESS STATE OF DENTURES AND ABUTMENT TEETH

The appropriate fit of removable partial dentures (RPDs) is hypothesized to lead to lower tooth mobility. An adhesive layer between the denture and oral mucosa can facilitate better denture retention and therefore increased stability. Study objectives were to model and compare the response of abutment structures with and without the application of a denture adhesive and to observe the stress response of abutment periodontal ligaments (PDLs) during the application of occlusal force on the RPD. A 3D finite element (FE) model was developed from computer tomography datasets of the mandibular region and the RPD. An adhesive layer was developed by extending the denture surface and using the Prony series approximation of rheological data to implement a viscoelastic material model. FE simulations were performed by applying a bite force on one of the denture segments, with the resulting deformation in PDL compared between the model with the adhesive layer and the base model without. The maximum deformation of 15[Formula: see text][Formula: see text]m was observed in the 2nd molar abutment PDL with the implementation of the adhesive, as compared to 42[Formula: see text][Formula: see text]m for the model without. The lower impact of RPDs on the supporting abutment teeth could potentially reduce the discomfort of denture wearers.

The Effect of Different Fiber Post-Application Techniques on Fracture Resistance of Structurally Compromised Premolars with Flared Root Canals: An In Vitro Study

Aim:

Intraradicular post systems have become an important treatment method for endodontically treated teeth as they provide retention for restoration to the remaining tooth structure. The objective of the present in vitro study was to evaluate the effect of different fiber post-application techniques on the fracture resistance of premolars with flared root canals and no ferrule.

Materials and Methods:

Sixty freshly extracted, single-rooted mandibular premolars with no ferrule were endodontically treated by an experienced endodontist, and their root canals were experimentally flared. The specimens with flared root canals were divided into five groups according to fiber post-application techniques ( n = 12): a prefabricated fiber post (G1), G1 + two auxiliary posts (G2), i-TFC post system (G3), G1 + quartz splint (G4), and Ribbond (G5). The data were analyzed with analysis of variance and Tukey tests.

Results:

The findings were revealed that no significant difference was found among four groups, except G5 ( P > .05), which demonstrated the lowest fracture resistance ( P < .05). G2, G3, G4, and G5 exhibited dominantly restorable fracture pattern, whereas G1 exhibited nonrestorable fracture pattern.

Conclusion:

Within the limitations of this study, the placement of auxiliary posts, i-TFC post system, quartz splint placement, and Ribbond increased the incidence of restorable fracture compared with the controls.

In Vitro Fracture Resistance of Endodontically Treated Premolar Teeth Restored with Prefabricated and Custom-Made Fibre-Reinforced Composite Posts

(1) Background: The study aimed to compare and analyse the differences between the features of prefabricated fibre-reinforced composite (FRC) posts and custom-made FRC posts in the form of a tape and confirm the necessity of using FRC posts in teeth treated endodontically in comparison to direct reconstruction with a composite material. (2) Methods: Sixty premolars after endodontic treatment were used. The teeth were divided into four groups (n-15). Group 1: teeth with embedded prefabricated posts (Mirafit White); group 2: teeth with embedded prefabricated posts (Rebilda); group 3 teeth with embedded custom-made posts in the form of a tape (EverStick); group 4: teeth without a post restored with composite material. The compressive strength of the teeth was tested using the Instron-5944 testing machine until the sample broke. The crystal structure of the investigated posts was detected with the X-ray diffractometer (3) Results: During the experiment, the maximum values of forces at which the damage of the restored premolar teeth after endodontic treatment occurred were obtained. The best results were obtained for teeth rebuilt with Rebilda Posts (1119 N), while teeth with cemented Mirafit White posts were the weakest (968 N). Teeth without an embedded FRC post, rebuilt only with light-cured composite material, obtained the lowest value-859 N. (4) Conclusions: The use of FRC posts increases the resistance to damage of an endodontically treated tooth when compared to direct restoration with light-cured composite material.

THE ROLE OF PDL-CEMENTUM ENTHESIS IN PROTECTING PDL UNDER MASTICATORY LOADING: A FINITE ELEMENT INVESTIGATION

Background: The function of periodontal ligament (PDL)-cementum enthesis (PCE) in transferring the mechanical stimuli within the tooth–periodontium (PDT)–bone complex was not made clear yet. This study aimed to evaluate the effects of PCE on the mechanical stimuli distribution within the PDL and alveolar bone in the tooth–PDT–bone complex under occlusal forces using the finite element method.

Methods: A computed tomography-based model of alveolar bone and second premolar of mandible was constructed, in which the PDT was considered at the interface of alveolar bone and tooth. Under a 3 MPa distributed occluso-apical masticatory load, applied over the uppermost surface of crown, the von Mises strain (vMST) and strain energy density (SED) within PDL, and von Mises stress (vMSR) and SED within alveolar bone were calculated in two situations: 1. When the PCE was absent; and 2. When the PCE was present between the PDL and cementum.

Results: PCE levels-off SED and vMST within PDL up to 59% and 27%, respectively, compared to the model with no PCE. Moreover, in the alveolar bone, SEDs and vMSR increased up to 28% and 30%, respectively, compared to the model without PCE.

Conclusion: By including PCE in the tooth–PDT–bone model, the mechanical stimuli shifted from PDL to its surrounding alveolar bone. Thus, it can be speculated that the tooth–PDT–bone complex has the capability of reducing the risk of PDL damage, through shifting excess mechanical stimuli from PDL toward the alveolar bone, during prolonged cyclic masticatory loading, as well as while one applies nonphysiologic and therapeutic loads, such as in orthodontic tooth movement.

Cementum thickening leads to lower whole tooth mobility and reduced root stresses: An in silico study on aging effects during mastication

In the course of a lifetime the crowns of teeth wear off, cementum thickens and the pulp closes-in or may stiffen. Little is known about how these changes affect the tooth response to load. Using a series of finite element models of teeth attached to the jawbone, and by comparing these to a validated model of a 'young' pig 3-rooted tooth, the effects of these structural changes were studied. Models of altered teeth show a stiffer response to mastication even when material properties used are identical to those found in 'young' teeth. This stiffening response to occlusal loads is mostly caused by the thicker cementum found in 'old' teeth. Tensile stresses associated with bending of dentine in the roots fall into a narrower distribution range with lower peak values. It is speculated that this is a possible protective adaptation mechanism of the aging tooth to avoid fracture. The greatest reduction in lateral motion was seen in the bucco-lingual direction. We propose that greater tooth motion during mastication is typical for the young growing animal. This motion is reduced in adulthood, favoring less off-axis loading, possibly to counteract natural bone resorption and consequent compromised anchoring.

Fatigue failure of anterior teeth without ferrule restored with individualized fiber-reinforced post-core foundations

OBJECTIVES

The aim was to explore the survival of extensively damaged anterior teeth without ferrule restored with different fiber-reinforced composite (FRC) post-core foundations and composite crowns.

MATERIALS AND METHODS

Sixty extracted upper central incisors were decoronated and randomly divided into four groups (n = 15). After endodontic treatment, the specimens were restored with different individualized fiber-reinforced post-core foundations as follows: control group (CTRL): multiple unidirectional FRC-post + dual-cure composite-core, PFC: multiple unidirectional FRC-post + packable short fiber-reinforced composite (SFRC), BPFC: Bioblock technique with only packable SFRC, BFFC: Bioblock technique with only flowable SFRC. After core build-up, the teeth were finalized with adhesively luted CAD/CAM composite crowns. Cyclic isometric loading (5 Hz) was applied at 100 N for 5000 cycles, and then 200 N and 300 N for 15,000 cycles each in a fluid chamber. The specimens were loaded until fracture occurred or when a total of 35,000 cycles were reached. Kaplan-Meyer survival analysis was conducted, followed by pairwise log-rank post hoc comparisons (Mantel-Cox).

RESULTS

The survival rates of the control (8279 cycles) and PFC (6161 cycles) were significantly higher compared to BPFC (3223 cycles) and BFFC (2271 cycles) (p < 0.05). Regarding fracture pattern, nearly all specimens fractured in a restorable manner.

CONCLUSIONS

For restoring extensively damaged anterior teeth, multiple unidirectional FRC posts are recommended.

CLINICAL RELEVANCE

Although different FRC post/core systems are available for the restoration of damaged root canal treated anterior teeth, multiple unidirectional FRC posts tend to be a good option when the ferrule is missing.

Evaluation of two CAD/CAM materials for Nayyar core and post-retained restorations: Three dimensional stress analysis

OBJECTIVES

The aim of this study is to assess the stress distribution of a nanoceramic resin CAD/CAM material, Lava Ultimate (LU) and a polymer-infiltrated hybrid ceramic CAD/CAM material, Vita Enamic (VE) for enamel replacement for Nayyar core (corono-radicular dowel and core) or post-retained restoration designs of a maxillary first premolar tooth with missing palatal cusp.

MATERIALS AND METHODS

A three dimensional finite element (FE) modelof maxillary first premolar with two roots was modeled. A mesial-occlusal-distal-palatal (MODP) cavity was designed with cavity floor above cemento-enamel junction and including buccal cuspal reduction. Restoration designs consisted of Nayyar core restoration (NCR) and post-retained restoration (PRR) with a glass fiber post. Vita Enamic (VE), Lava Ultimate (LU) were used for enamel and everX Posterior was used for dentin replacement. Vertical occlusal load (100 N) was applied on a spherical solid rigid material simulating the food stuff. Von Mises (VM) and maximum principle stress values were evaluated separately for the remaining enamel, remaining dentin and restorative material in megapascal (MPa).

RESULTS

The analysis of both VM and maximum principle stress values revealed that the most intense stress accumulation was in the cervical region of enamel for both designs. For VM, similar stress values were observed only in dentin. Stress analysis of restorative materials showed that everX Posterior had the highest stress accumulation.

CONCLUSIONS

The comparison of the two techniques showed that PRR had better stress distribution than NCR. NCR or PRR with LU or VE exhibited similar VM stress accumulation in dentin. Maximum principle stress analyses showed that PRR with LU transmitted the least stress to enamel and dentin indicating that when LU is the material of choice, post-retained restoration would be a satisfactory design. VM stress values of enamel revealed that VE absorbed the stress in itself and transferred less stress to dentin. This could point out that for the restoration of maxillary first premolar tooth with missing palatal cusp, VE may be a suitable material for NCR and PRR restoration techniques.

HIGHLIGHTS

When fiber reinforced composite is used as dentin replacement in combination with VE as enamel replacement; any technique; PRR or NCR, may be preferred in the restoration of MODP cavities of endodontically treated maxillary premolars. The clinical relevance has to be further studied in-vivo.

Influence of single post, oval, and multi-post restorative techniques and amount of residual tooth substance on fracture strength of endodontically treated maxillary premolars

PURPOSE

The aim of this study was to compare the influence of the number of coronal walls and post-endodontic restorations on the mechanical strength of 165 recently extracted endodontically treated maxillary premolars.

METHODS

The teeth were divided into 3 control (no post) and 3 test groups according to the number of residual walls. Each test group was divided into subgroups according to the type of post-endodontic restoration (single, oval, and multi-post techniques). Samples were prepared conforming to the assigned subgroup. A universal loading machine applied a load parallel to the longitudinal axis of the teeth, thus simulating physiological occlusion. ANOVA and the Kruskal Wallis test were used for comparisons (P ≤ 0.05), and Tukey's test for multiple comparisons.

RESULTS

For intact teeth, significant differences were found among all 3 subgroups, with single post showing the highest values. For 3 residual walls, oval post resulted in significantly lower values than single and multi-post systems. For 2 residual walls, the multi-post technique showed almost twice the resistance of oval post restorations.

CONCLUSION

In oval canals the use of a single or multi-post technique increased post-and-core resistance even in intact teeth, whereas oval fiber posts showed no improvements. Multi-post design improved fracture resistance mostly in maxillary premolars lacking both marginal ridges.

Mechanical performance of Anatomic-Functional-Geometry dental treatments: A computational study

In this paper the biomechanical response of a novel dental preparation technique, referred to as the Anatomic-Functional-Geometry treatment (AFG), is investigated through a 3D nonlinear finite-element modelling approach. A comparative investigation against a standard technique employed in dental clinical practice is carried out, by simulating typical experimental mechanical tests and physiological functional conditions. Failure mechanisms of treated tooth models are investigated through a progressive damage formulation implemented via a displacement-driven incremental approach. Computational results clearly show that AFG-treated teeth, as a consequence of a more conservative morphological preparation of the tooth, are characterized by more effective crown-dentin loading transfer mechanisms, higher fracture strength levels and more homogeneous stress patterns than the standard-treated ones, thereby opening towards widespread clinical application.

Evaluation of Maximum Principal Stress, Von Mises Stress, and Deformation on Surrounding Mandibular Bone During Insertion of an Implant: A Three-Dimensional Finite Element Study

Aim The present study evaluated maximum principal stress, von Mises stress, and deformation on the mandible and surrounding structures during the insertion of an implant in various anatomical positions. Materials and Methods Finite element models of straight two-piece implants of 4.5 mm × 11.5 mm were modeled using Ansys software, v. 16.0 (Ansys, Inc., Houston, TX, USA). The mandibular model was derived through cone-beam computed tomography of a cadaveric mandible using Mimics software (Materialise NV, Leuven, Belgium). An osteotomy was performed at the first molar region, second premolar region, lateral incisor region, central incisor region, canine region, and second molar region that had varying bone densities. Implant insertion was simulated with a variable load of 1 - 180 Newton, which was applied axially downward with a rotational velocity of 30 - 120 rpm. Maximum principal stresses, von Mises stress distribution at the implant insertion site, and maximum deformation on the entire mandible were recorded during the insertion of the implants. Results Maximum principal stress was highest in the crestal area of the right first molar region and least in the middle third of the central incisor region during implant insertion. Von Mises stress in the mandible was highest in the right first molar region and the least in the lateral incisor region during implant insertion. The extent deformation was recorded on the x-axis, y-axis, and z-axis of the mandible. Deformation on the x-axis was highest at the crestal region of the canine and least for the lateral incisor. On the y-axis, deformation was highest at the symphysis region during implant insertion at the first molar region and the least at the condylar area during implant placement in the canine area. On the z-axis, the deformation was highest at the condylar region during implant insertion at the first molar region, and the least was observed in the symphysis region during implant placement in the second molar region. Conclusion When overall stress was considered, there is a direct correlation between stress and quality of bone. The highest maximum principal stress and von Mises stress were recorded during the placement of implants in posterior regions of the mandible, which suggests that the presence of dense cortical bone results in higher stress values. The maximum deformation was observed at different regions of the mandible, away from the site of implant insertion. The resultant stress and deformation exerted on the bone during placement of implants at different sites in the mandible varies, which could be detrimental factors in the longevity of the implant.

Custom and prefabricated PolyEtherKetoneKetone (PEKK) post-core systems bond strength: Scanning electron microscopy evaluation

The present study evaluated the bond strengths of prefabricated PolyEtherKetoneKetone (PEKK) posts, PEKK posts custom-configured according to root-canal size, and conventional fiber posts. A total of 30 maxillary incisors were randomly divided into three groups, as follows: Group 1: fiber posts; Group 2: prefabricated PEKK posts; Group 3; custom-made PEKK posts. Following endodontic treatment, post spaces were prepared, and posts were cemented with resin cement. Push-out bond strength testing was performed using a universal testing machine, and fractures modes were examined under a scanning electron microscope. Data were analyzed using One-way ANOVA and Tukey's HSD tests, with the level of significance set at .05. The highest bond-strength values in the cervical section were observed with the custom-made PEKK post (17.3470 MPa), whereas the highest bond-strength values in the middle and apical sections were observed with the conventional fiber posts (11.5375 MPa and 6.8625 MPa, respectively). Bond-strength values for all posts systems decreased in a cervical to apical direction. PEKK posts are a suitable alternative to fiber posts. Although custom-made PEKK posts demonstrated better bond strength than prefabricated PEKK posts, further studies are needed to evaluate their clinical performance.

Finite element modeling of the periodontal ligament under a realistic kinetic loading of the jaw system

Purpose

The stresses and deformations in the periodontal ligament (PDL) under the realistic kinetic loading of the jaw system, i.e., chewing, are difficult to be determined numerically as the mechanical properties of the PDL is variably present in different finite element (FE) models. This study was aimed to conduct a dynamic finite element (FE) simulation to investigate the role of the PDL (PDL) material models in the induced stresses and deformations using a simplified patient-specific FE model of a human jaw system.

Methods

To do that, a realistic kinetic loading of chewing was applied to the incisor point, contralateral, and ipsilateral condyles, through the experimentally proven trajectory approach. Three different material models, including the elasto-plastic, hyperelastic, and viscoelastic, were assigned to the PDL, and the resulted stresses of the tooth FE model were computed and compared.

Results

The results revealed the highest von Mises stress of 620.14 kPa and the lowest deformation of 0.16 mm in the PDL when using the hyperelastic model. The concentration of the stress in the elastoplastic and viscoelastic models was in the mid-root and apex of the PDL, while for the hyperelastic model, it was concentrated in the cervical margin. The highest deformation in the PDL regardless of the employed material model was located in the caudal direction of the tooth. The viscoelastic PDL absorbed the transmitted energy from the dentine and led to lower stress in the cancellous bone compared to the elastoplastic and hyperelastic material models.

Conclusion

These results have implications not only for understanding the stresses and deformations in the PDL under chewing but also for providing comprehensive information for the medical and biomechanical experts in regard of the role of the material models being used to address the mechanical behavior of the PDL in other components of the tooth.

Fracture resistance of metal-ceramic crown copings cemented to two types of intra-radicular posts

Abstract Introduction Endodontically treated teeth are more susceptible to root fracture than vital teeth. In order to reduce the risk of fracture, the use of intra-radicular posts and crowns is indicated. However, their own fracture resistance remains unclear. Objective To analyze the behavior of metal-ceramic crown copings cemented to two types of intra-radicular posts under tensile stress. Material and method Sixteen metal-ceramic crown copings cemented with zinc phosphate cement to cast metal posts and cores (group 1, n = 8) or with self-adhesive resin cement to glass-fiber posts rebased with composite resin (group 2, n = 8) were subjected to tensile testing after endodontic treatment and standardized preparation. Failure occurred when the crown coping and/or post-core assembly fractured and/or detached. Result In group 1, after the application of a mean tensile load of 46.83 N, 7 crown copings and metal cores separated as a whole, while in 1 specimen the coping detached from the metal core. In group 2, a mean tensile load of 127.68 N resulted in glass-fiber post fracture, and in 1 case the entire crown-post-core assembly was detached. Tensile strength differed significantly between the two groups (p = 0.0085). Conclusion Our findings suggest that metal-ceramic crown copings cemented with self-adhesive resin cement show strong adhesion to composite resin cores associated with glass-fiber posts, thus providing a safe alternative to the use of cast metal posts and cores.

The Effect of Intraradicular Multiple Fiber and Cast Posts on the Fracture Resistance of Endodontically Treated Teeth with Wide Root Canals

Introduction

The endodontically treated teeth (ETT) with thin remaining radicular dentin thickness are predisposed to fracture; hence it requires the diligent selection and the execution of endodontic post treatment. The objective of the study was to evaluate the reinforcing effect of both multiple fiber reinforced composite (FRC) and Ni-Cr cast metal posts at anterior and posterior regions.

Material and Methods

Forty recently extracted root canal treated canine and single rooted premolar teeth were used for the study. They were randomly divided into four groups (n=10) as: Group 1, single FRC post; Group 2, multiple FRC posts; Group 3, single Ni-Cr metal post, Group 4, multiple Ni-Cr posts. The posts were cemented with self-adhesive resin cement and subsequently restored with full veneer metal crown. The compressive static load at 130⁰ for canine and 45⁰ for premolar was applied with the cross-head speed of 0.5mm/minute until the fracture. The obtained data was analyzed using the Kruskal–Wallis and Pairwise comparison tests with SPSS.

Results

The results indicate that multiple FRC post restored canine had the maximum fracture load (1843.80±7.13 N), followed by cast multiple posts (1648.99±26.84 N), single fiber post (1623±40.31 N), and cast metal single post (1493±27.33 N). A similar trend was observed in premolar with higher max fracture load with multiple FRC posts at 1920.86±20.61 N and multiple cast metal posts at 1735.43±6.05 N.

Conclusion

The restoration of ETT with larger canals by multiple FRC and metal posts provides substantially higher fracture resistance in comparison to wider single post.

Effect of Load Cycling on the Fracture Strength/Mode of Teeth Restored with FRC Posts or a FRC Liner and a Resin Composite

The aim of the study was to comparatively evaluate the fracture strength and mode of root canal treated teeth restored with resin composites with and without posts. The lingual cusps of root canal treated first upper premolars (n = 10/group) were removed down to cervical enamel and restored with the following: group A: glass-fiber post (Glassix) followed by a particulate-filled composite resin (PFC, G-aenial posterior, 3 × 2 mm layers); group B: glass-fiber reinforced composite bulk fill liner (EverX posterior, 4 mm layer) with the PFC (2 mm layer). Specimens were immersed in H2O (1 w/37°C), then subjected to load cycling (50 N/0.2 Hz/200k cycles), and fractured under compressive loading. Failure mode was characterized by stereomicroscopy. Statistical analysis was performed by Mann-Whitney (load) and Chi-square (mode) at a = 0.05. No statistically significant differences (p = 0.273) were found in fracture load between median values of groups A (860 N) and B (1059 N). In group A, 60% of the specimens demonstrated catastrophic root fractures and 40% mixed crown fractures (tooth cusp and restoration), whereas in group B, no root fractures were found, and the failure modes were equally distributed between mixed fractures as above and fracture of the buccal cusp. These differences were statistically significant (p = 0.004). The combination of the glass-FRC bulk fill liner with the PFC diminished the catastrophic root fractures induced by FRC posts, at a similar or higher fracture load.

Multi-Fiber-Reinforced Composites for the Coronoradicular Reconstruction of Premolar Teeth: A Finite Element Analysis

A coronoradicular reconstruction (CRR) has conventionally used a metallic inlay core (MIC) or a single-fiber-reinforced composite (sFRC) but extensive dentin removal can lead to root fracture. We propose herein a multi-fiber-reinforced composite (mFRC) based on a bundle of thin flexible fibers that can be adapted to the root anatomy without removing additional dentin. The aim of this study was to compare the mechanical behavior of the root reconstructed with mFRC, MIC, or sFRC using a finite element analysis (FEA). Models with or without a ferrule effect were created using Autodesk© software and divided into four parts: root, post, bonding composite or cement, and zirconia crown. For both models, extreme stress values (ESV), stress distribution, and risk of fracture were calculated for an oblique force (45°) of 100 N applied to the top of the buccal cusp. Results indicated that mFRC and mFRCG present a lower risk of fracture of the root and of the CRR without ferrule and thus could be valuable alternatives for premolar CRR. Further studies are necessary to evaluate the clinical success of these CRR.

Comparison of the Microtensile Bond Strength of a Polyetherketoneketone (PEKK) Tooth Post Cemented with Various Surface Treatments and Various Resin Cements

The aim of this in-vitro research was to evaluate the microtensile bond strength in the newly introduced PEKK tooth post with various surface treatments and resin cements. A fiberglass tooth post was included in order to compare it with PEKK as a possible post material. The microtensile bond strengths of the fiberglass post (FRC Postec Plus) and the PEKK post (Pekkton^®) were tested using three kinds of self-adhesive resin cements (G-CEM LinkAce, Multilink Speed, and RelyX U200) and one self-etching resin cement (PANAVIA F2.0). The surface treatments of the fiberglass posts were processed according to the manufacturer’s recommendations (F1, application of 37% phosphoric acid etching gel and silanization). For the PEKK post groups, various surface treatments were performed like no surface treatment (P1), sandblasting (P2), silica-coating and silanization (P3), and sandblasting with a composite primer (P4). In the surface treatment, PEKK posts with silica coating and silane treatment (P3) showed a significantly higher microtensile bond strength (mean MPa: 18.09, p < 0.05). The highest microtensile bond strength was shown when the PEKK posts were treated with a silica coating and silane treatment and cemented with RelyX U200 (mean MPa: 22.22). The PEKK posts with surface treatments of silica-coating and silanization or sandblasting displayed superior microtensile bond strengths (mean MPa: 18.09 and 16.25, respectively) compared to the conventional fiberglass posts (mean MPa: 14.93, p < 0.05).

Stress distributions in internal resorption cavities restored with different materials at different root levels: A finite element analysis study

The aim of this study was to evaluate the stresses within simulated roots with internal resorption cavities at the apical, middle and coronal root levels, after obturation with gutta-percha and/or MTA utilising finite element analysis (FEA). Mandibular premolar teeth with internal resorption cavities at different root levels were modelled. Models were restored with gutta-percha and/or MTA. An oblique force of 300 N was applied and stress evaluations were carried out. In the MTA-filled resorption models, the stresses were distributed more homogeneously than the gutta-percha filled models, and the stress concentrations were lower in the remaining dentinal tissues. If the whole root is considered, the fully gutta-percha-filled models generated the highest stress values. Differences between the fully MTA-filled models and hybrid techniques were present only in the apical resorption models. Both the MTA and combination of MTA and gutta-percha can be suggested for use in clinical practice, in cases of internal root resorption cavity obturation.

A novel approach for early evaluation of orthodontic process by a numerical thermomechanical analysis

The main objective of this paper is to propose a novel method that provides an opportunity to evaluate an orthodontic process at early phase of the treatment. This was accomplished by finding out a correlation between the applied orthodontic force and thermal variations in the tooth structure. To this end, geometry of the human tooth surrounded by the connective soft tissue called the periodontal ligament and the bone was constructed by employing dental CT scan images of a specific case. The periodontal ligament was modeled by finite strain viscoelastic model through a nonlinear stress-strain relation (hyperelasticity) and nonlinear stress-time relation (viscoelasticity). The tooth structure was loaded by a lateral force with 15 different quantities applied to 20 different locations, along the midedge of the tooth crown. The resultant compressive stress in the periodontal ligament was considered as the cause of elevated cell activity that was modeled by a transient heat flux in the thermal analysis. The heat flux value was estimated by conducting an experiment on a pair of rats. The numerical results showed that by applying an orthodontic force to the tooth structure, a significant temperature rise was observed. By measuring the temperature rise, the orthodontic process can be evaluated.

Effect of Endocrown Restorations with Different CAD/CAM Materials: 3D Finite Element and Weibull Analyses

The aim of this study was to evaluate the effects of two endocrown designs and computer aided design/manufacturing (CAD/CAM) materials on stress distribution and failure probability of restorations applied to severely damaged endodontically treated maxillary first premolar tooth (MFP). Two types of designs without and with 3 mm intraradicular extensions, endocrown (E) and modified endocrown (ME), were modeled on a 3D Finite element (FE) model of the MFP. Vitablocks Mark II (VMII), Vita Enamic (VE), and Lava Ultimate (LU) CAD/CAM materials were used for each type of design. von Mises and maximum principle values were evaluated and the Weibull function was incorporated with FE analysis to calculate the long term failure probability. Regarding the stresses that occurred in enamel, for each group of material, ME restoration design transmitted less stress than endocrown. During normal occlusal function, the overall failure probability was minimum for ME with VMII. ME restoration design with VE was the best restorative option for premolar teeth with extensive loss of coronal structure under high occlusal loads. Therefore, ME design could be a favorable treatment option for MFPs with missing palatal cusp. Among the CAD/CAM materials tested, VMII and VE were found to be more tooth-friendly than LU.

Flexural strength of fiber reinforced posts after mechanical aging by simulated chewing forces

This study evaluated the effect of simulated chewing forces on the flexural strength of fiber reinforced posts (FRPs). Four different brands of FRPs were selected as main group for the study: RelyX Fiber Post (RX), IceLight (ICE), Unicore Posts (UC), FlouroPost (FP). Ten posts in each main group didn't receive any aging process and tested as baseline (BL), other ten posts were subjected to simulated chewing forces/mechanical aging (MA) as follows: Post spaces were prepared in acrylic with drill. Depth of preparation was adjusted to leave 4-mm coronal part of posts protruding from canals. Coronal parts were incrementally restored with resin-composite (Clearfil Majesty Posterior A2, Kuraray, Osaka, Japan). Prepared samples were subjected to chewing cycles in a chewing simulator (Chewing Simulator CS-4, Mechatronik, Germany). Flexural strengths of all groups were measured with three-point bending test. Data were analyzed by two-way ANOVA and Tukey's test (α = 0.05). After MA, flexural strengths of all posts were significantly decreased when compared with BL for all FRPs tested (p < 0.05). At BL, highest flexural strength values were obtained for ICE. After MA, similar to BL, highest flexural strength values were obtained for ICE. Only RX showed statistically significant difference when compared with ICE (p < 0.05). UC and FP showed similar flexural strength values with ICE (p > 0.05). It may be concluded that chewing forces on post-core systems may reduce the flexural strengths of FRPs.

A New Model to Study Fatigue in Dental Implants Based on Probabilistic Finite Elements and Cumulative Damage Model

The aim of this study was to predict the fatigue life of two different connections of a dental implant as in load transfer to bone. Two three-dimensional models were created and assembled. All models were subjected to a natural masticatory force of 118 N in the angle of 75° to the occlusal plane. All degrees of freedom in the inferior border of the cortical bone were restrained, and the mesial and distal borders of the end of the bone section were constrained. Fatigue material data and loads were assumed as random variables. Maximum principal stresses on bone were evaluated. Then, the probability of failure was obtained by the probabilistic approach. The maximum principal stress distribution predicted in the cortical and trabecular bone is 32 MPa for external connection and 39 MPa for internal connection. A mean life of 103 and 210 million cycles were obtained for external and internal connection, respectively. Probability cumulative function was also evaluated for both connection types. This stochastic model employs a cumulative damage model and probabilistic finite element method. This methodology allows the possibility of measured uncertainties and has a good precision on the results.

Influence of nickel-titanium rotary systems with varying tapers on the biomechanical behaviour of maxillary first premolars under occlusal forces: a finite element analysis study

AIM

To evaluate the effect of three nickel-titanium (Ni-Ti) rotary systems with varying tapers on stress distribution and to analyse potential fracture patterns as well as the volume of fracture-susceptible regions in two-rooted maxillary premolars.

METHODOLOGY

The root canals of three single-rooted premolars were prepared with either HeroShaper (Micro-Mega, Besançon, France) to (size 30, .04 taper), Revo-S (Micro-Mega) to AS30 (size 30, .06 taper) or ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) to F3 (size 30, .09 taper) Ni-Ti files. The three root canals were scanned using micro-computed tomography (μCT) (Skyscan 1174, Skyscan, Kontich, Belgium) and modelled according to the μCT data. An intact tooth model with a root length of 16 mm was also constructed based on μCT images of an extracted maxillary premolar with two roots. New models were constructed by replacing both of the original canals of the intact two-rooted premolar model with the modelled canals prepared with the HeroShaper, Revo-S or ProTaper Universal system. Occlusal forces of 200 N were applied in oblique and vertical directions. Finite element analysis was performed using Abaqus FEA software (Abaqus 6.14, ABAQUS Inc., Providence, RI, USA).

RESULTS

Upon the application of oblique occlusal forces, the palatal external cervical root surface and the bifurcation (palatal side of the buccal root) in tooth models experienced the highest maximum principal (Pmax) stresses. The application of vertical forces resulted in minor Pmax stress values. Models prepared using the ProTaper system exhibited the highest Pmax stress values. The intact models exhibited the lowest Pmax stress values followed by the models prepared with the HeroShaper system.

CONCLUSION

The differences in Pmax stress values amongst the different groups of models were mathematically minimal under normal occlusal forces. Rotary systems with varying tapers might predispose the root fracture on the palatal side of the buccal root and cervical palatal root surface in two-rooted premolars.

Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis

The aim of this study was to evaluate the biomechanical behavior and long-term safety of high performance polymer PEKK as an intraradicular dental post-core material through comparative finite element analysis (FEA) with other conventional post-core materials. A 3D FEA model of a maxillary central incisor was constructed. A cyclic loading force of 50 N was applied at an angle of 45° to the longitudinal axis of the tooth at the palatal surface of the crown. For comparison with traditionally used post-core materials, three materials (gold, fiberglass, and PEKK) were simulated to determine their post-core properties. PEKK, with a lower elastic modulus than root dentin, showed comparably high failure resistance and a more favorable stress distribution than conventional post-core material. However, the PEKK post-core system showed a higher probability of debonding and crown failure under long-term cyclic loading than the metal or fiberglass post-core systems.

Effect of fibre posts, bone losses and fibre content on the biomechanical behaviour of endodontically treated teeth: 3D-finite element analysis

The aim of this work was to evaluate the stress distribution inside endodontically treated teeth restored with different posts (glass fibre, carbon fibre and steel posts) under different loading conditions by using a 3D-finite element analysis. The effect of masticatory and impact forces on teeth with different degrees of bone loss was analysed. The model consists of: dentine, post, cement, gutta-percha, core and crown. Four simulations were conducted with two static forces (170N horizontal and 100N oblique) and two sections constrained: 1mm (alveolar bone position in a normal periodontium) and 6mm (middle of root) below the crown. Von Mises and the principal stresses were evaluated and analysed with a 3-way ANOVA and Tukey test (α=0.05) and the effect of fibre percentage analysed. Significant differences were found among the stress values for all conditions (p<0.05). Impact load was always responsible for the most critical situation especially when the bone loss was more evident. The system with steel posts showed the highest principal stresses at the post-cement interface with horizontal load and top constraints (compressive stress of 121MPa and tensile stress of 115MPa). The use of glass posts provides a more homogeneous behaviour of the system with lower stresses. Higher fibre percentages gave higher stress in the posts. Moreover, larger bone losses are responsible for important increase in stress. Thus, this work demonstrated that periodontal disease has an important role in the success of tooth restoration after endodontic therapy, influencing the choice of post material and depth.

Modeling of damage driven fracture failure of fiber post-restored teeth

Mechanical failure of biomaterials, which can be initiated by either violent force, or progressive stress fatigue, is a serious issue. Great efforts have been made to improve the mechanical performances of dental restorations. Virtual simulation is a promising approach for biomechanical investigations, which presents significant advantages in improving efficiency than traditional in vivo/in vitro studies. Over the past few decades, a number of virtual studies have been conducted to investigate the biomechanical issues concerning dental biomaterials, but only with limited incorporation of brittle failure phenomena. Motivated by the contradictory findings between several finite element analyses and common clinical observations on the fracture resistance of post-restored teeth, this study aimed to provide an approach using numerical simulations for investigating the fracture failure process through a non-linear fracture mechanics model. The ability of this approach to predict fracture initiation and propagation in a complex biomechanical status based on the intrinsic material properties was investigated. Results of the virtual simulations matched the findings of experimental tests, in terms of the ultimate fracture failure strengths and predictive areas under risk of clinical failure. This study revealed that the failure of dental post-restored restorations is a typical damage-driven continuum-to-discrete process. This approach is anticipated to have ramifications not only for modeling fracture events, but also for the design and optimization of the mechanical properties of biomaterials for specific clinically determined requirements.

Stress distribution of oval and circular fiber posts in amandibular premolar: a three-dimensional finite element analysis

PURPOSE

The aim of the present study was to evaluate the effects of posts with different morphologies on stress distribution in an endodontically treated mandibular premolar by using finite element models (FEMs).

MATERIALS AND METHODS

A mandibular premolar was modeled using the ANSYS software program. Two models were created to represent circular and oval fiber posts in this tooth model. An oblique force of 300 N was applied at an angle of 45° to the occlusal plane and oriented toward the buccal side. von Mises stress was measured in three regions each for oval and circular fiber posts.

RESULTS

FEM analysis showed that the von Mises stress of the circular fiber post (426.81 MPa) was greater than that of the oval fiber post (346.34 MPa). The maximum distribution of von Mises stress was in the luting agent in both groups. Additionally, von Mises stresses accumulated in the coronal third of root dentin, close to the post space in both groups.

CONCLUSION

Oval fiber posts are preferable to circular fiber posts in oval-shaped canals given the stress distribution at the post-dentin interface.

Mechanical effect of static loading on endodontically treated teeth restored with fiber-reinforced posts

The aim of this study was to investigate the mechanical behavior of a dental system built up with fiber-reinforced composite (FRC) endodontic posts with different types of fibers and two cements (the first one used with a primer, the second one without it). Six FRC posts were used. Each system was characterized in terms of structural efficiency under external applied loads similar to masticatory forces. An oblique force was applied and stiffness and maximum load data were obtained. The same test was used for the dentine. The systems were analyzed by scanning electron microscope (SEM) to investigate the surface of the post and inner surface of root canal after failure. The mechanical tests showed that load values in dental systems depend on the post material and used cement. The highest load (281 ± 59 N) was observed for the conical glass fiber posts in the cement without primer. There was a 50 and 85% increase in the maximum load for two of the conical posts with glass fibers and a 229% increase for the carbon fiber posts in the cement without primer as compared with the cement with primer. Moreover, almost all the studied systems showed fracture resistances higher than the typical masticatory loads. The microscopic analysis underlined the good adhesion of the second cement at the interfaces between dentine and post. The mechanical tests confirmed that the strength of the dental systems subjected to masticatory loads was strictly related to the bond at the interface post/cement and cement/dentine.

Finite element analysis of multi-piece post-crown restoration using different types of adhesives

The multi-piece post-crown technique is more effective in restoring residual root than other restoration techniques. Various types of adhesives have different material properties that affect restoration. Therefore, the choice of adhesive is particularly important for patients. However, the effect of different kinds of adhesives was not too precise by experimental methods when concerning about individual differences of teeth. One tooth root can only be restored with one type of adhesive in experiment. After the mechanical test, this tooth root cannot be restored with other adhesives. With the help of medical imaging technology, reverse engineering and finite element analysis, a molar model can be reconstructed precisely and restored using different types of adhesives. The same occlusal and chewing loads were exerted on the same restored residual root models with different types of adhesives separately. Results of von Mises stress analysis showed that the adhesives with low Young's modulus can protect the root canal effectively. However, a root canal concentration is apparently produced around the root canal orifice when chewing. Adhesives with large Young's modulus can buffer the stress concentration of the root canal orifice. However, the root canal tissue may be destroyed because the adhesive is too hard to buffer the load.

Comparative evaluation of osseointegrated dental implants based on platform-switching concept: influence of diameter, length, thread shape, and in-bone positioning depth on stress-based performance

This study aimed to investigate the influence of implant design (in terms of diameter, length, and thread shape), in-bone positioning depth, and bone posthealing crestal morphology on load transfer mechanisms of osseointegrated dental implants based on platform-switching concept. In order to perform an effective multiparametric comparative analysis, 11 implants different in dimensions and in thread features were analyzed by a linearly elastic 3-dimensional finite element approach, under a static load. Implant models were integrated with the detailed model of a maxillary premolar bone segment. Different implant in-bone positioning levels were modeled, considering also different posthealing crestal bone morphologies. Bone overloading risk was quantified by introducing proper local stress measures, highlighting that implant diameter is a more effective design parameter than the implant length, as well as that thread shape and thread details can significantly affect stresses at peri-implant bone, especially for short implants. Numerical simulations revealed that the optimal in-bone positioning depth results from the balance of 2 counteracting effects: cratering phenomena and bone apposition induced by platform-switching configuration. Proposed results contribute to identify the mutual influence of a number of factors affecting the bone-implant loading transfer mechanisms, furnishing useful insights and indications for choosing and/or designing threaded osseointegrated implants.

Life prediction of different commercial dental implants as influence by uncertainties in their fatigue material properties and loading conditions

Probabilistic analyses allow the effect of uncertainty in system parameters to be determined. In the literature, many researchers have investigated static loading effects on dental implants. However, the intrinsic variability and uncertainty of most of the main problem parameters are not accounted for. The objective of this research was to apply a probabilistic computational approach to predict the fatigue life of three different commercial dental implants considering the variability and uncertainty in their fatigue material properties and loading conditions. For one of the commercial dental implants, the influence of its diameter in the fatigue life performance was also studied. This stochastic technique was based on the combination of a probabilistic finite element method (PFEM) and a cumulative damage approach known as B-model. After 6 million of loading cycles, local failure probabilities of 0.3, 0.4 and 0.91 were predicted for the Lifecore, Avinent and GMI implants, respectively (diameter of 3.75mm). The influence of the diameter for the GMI implant was studied and the results predicted a local failure probability of 0.91 and 0.1 for the 3.75mm and 5mm, respectively. In all cases the highest failure probability was located at the upper screw-threads. Therefore, the probabilistic methodology proposed herein may be a useful tool for performing a qualitative comparison between different commercial dental implants.