Effect of half-digital workflows on the adaptation of custom CAD-CAM composite post-and-cores

Evaluation of the accuracy of two full-digital versus half-digital techniques for post-and-core with different root canal entrance diameters

PURPOSE

With the advancement in digital technology, post-and-cores can be produced using full-digital techniques. This study aimed to evaluate the accuracy of two full-digital impression techniques for scanning the post space with different root canal entrance diameters using an intraoral scanner (IOS) (TRIOS 3) with and without a scan post, compared to the half-digital impression technique.

METHODS

Standard models of three intact teeth with varying root canal entrance diameters were prepared. Fifteen post-and-core designs per tooth were created using direct IOS and IOS with scan posts, with the half-digital technique as the control. All files were exported as standard tessellation language (STL) files, and the root mean square (RMS) deviations were analyzed between the experimental and control groups. Deviations were measured at standardized points across four regions: the occlusal external, occlusal internal, middle third, and apical third.

RESULTS

No significant differences in the overall RMS were observed among the different root canal entrance diameters (3 mm, 4 mm, and 5 mm) for direct IOS and IOS with scan posts (P > 0.05). However, an independent samples t-test revealed a significant difference (P < 0.05) in both trueness and precision between the two experimental groups, with IOS with scan posts consistently showing lower RMS values.

CONCLUSIONS

For post space lengths less than 7.4 mm in single-rooted teeth, both direct IOS and IOS with scan posts can serve as viable alternatives to half-digital techniques. However, in deeper areas, IOS with scan posts are recommended as alternatives to the half-digital technique.

Trueness and depth discrepancy of post-space scans using an intraoral scanner: influence of preparation dimensions: an in vitro study

BACKGROUND

Intraoral scanning of post spaces offers a potential alternative to conventional impressions, but its effectiveness depends on overcoming limitations influenced by post space dimensions.

AIM OF THE STUDY

This study aimed to evaluate the trueness and depth discrepancy percentage of scanned post spaces with different dimensions using an intraoral scanner.

MATERIALS AND METHODS

Twenty single-rooted human maxillary canines were endodontically treated. Teeth were assigned to two post space preparation width groups: N (Ø1.5 mm) and W (Ø1.7 mm) (n = 10 per group). Each width group was further subdivided into two depth subgroups: S (6 mm) and L (10 mm) (n = 5 per subgroup). This resulted in four experimental subgroups: NS (Ø1.5 mm, 6 mm), NL (Ø1.5 mm, 10 mm), WS (Ø1.7 mm, 6 mm), and WL (Ø1.7 mm, 10 mm). Specimens were scanned using the Panda P2 intraoral scanner (IOS), and the obtained STL files were aligned and compared with those from traditional impressions scanned with the InEos X5. Trueness and depth discrepancy percentage were evaluated using reverse engineering software. The data were statistically analysed using a Two-Way ANOVA, followed by multiple pairwise comparisons using Tukey's HSD for each individual factor.

RESULTS

Preparation width had no significant effect on trueness (p > 0.05), whereas increasing preparation depth significantly reduced it. Additionally, a greater preparation width significantly decreased the depth discrepancy percentage, while increasing preparation depth led to a significant increase. A statistically significant, very strong positive correlation was observed between RMS and depth discrepancy percentage (r = 0.898), indicating that greater deviations in trueness were associated with increased depth discrepancies.

CONCLUSIONS

Within the study's limitations, trueness improved by reducing post space depth and remained clinically acceptable for all subgroups. However, increasing depth to 10 mm raised the depth discrepancy beyond the clinically acceptable range, while decreasing width also increased discrepancy.

CLINICAL TRIAL NUMBER

Not applicable.

The accuracy of direct digital impressions of post spaces with different diameters and depths scanned by a wireless intraoral scanner

OBJECTIVES

To assess the accuracy of a wireless intraoral scanner (IOS) in scanning post spaces with different diameters and depths.

METHODS

Six maxillary central incisors underwent endodontic treatment and tooth preparation. Post space preparation was performed using a #4 or #6 post drill to depths of 6, 8, and 10 mm, respectively. Direct digital impressions of the post spaces were scanned using an IOS (Trios 5, 3Shape, Copenhagen, Denmark) ten times as test data. Conventional impressions were also taken and subsequently scanned using a laboratory scanner to serve as reference data. The accuracy of the test data was evaluated through both 3D and 2D comparisons against the reference data. Statistical analysis was performed using analysis of variance (α=0.05).

RESULTS

As post space depth increased or diameter decreased, 3D root mean square (RMS) values increased, ranging from 65.7 μm to 82.8 μm (p < 0.001), while the proportion of green region (indicating a deviation within 0.1 mm) decreased from 90.05 % to 76.38 % (p < 0.001). 2D RMS values gradually decreased from the cervical to the apical region. Except for the apical region in the #4 drill group with a 10 mm depth, all 3D and 2D RMS values remained below 100 μm. Furthermore, only the post space with a 10 mm depth in the #4 drill group exhibited a proportion of green region <80 %.

CONCLUSIONS

The accuracy of the wireless IOS in post space scanning was significantly affected by both depth and diameter, and decreased with increasing depth or decreasing diameter. Furthermore, the accuracy diminished as the scan approached the apical region.

CLINICAL SIGNIFICANCE

When the depth of post space prepared with a 1.9 mm diameter drill is ≤8 mm or when prepared with a 2.25 mm diameter drill is ≤10 mm, Trios 5 is suitable for direct digital impressions.

Trueness and intaglio fit of custom-made polyetheretherketone post-and-cores fabricated using different techniques

STATEMENT OF PROBLEM

Applications of polyetheretherketone (PEEK) as a promising alternative to ceramic materials have extended to include post-and-cores. However, information regarding the available fabrication techniques for producing custom-made PEEK post-and-cores and their effect on accuracy is still scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the trueness and intaglio fit of custom-made PEEK post-and-cores fabricated using different techniques.

MATERIAL AND METHODS

Ten mandibular second premolars were collected, decoronated, and endodontically treated. For the fabrication of custom-made post-and-cores, each post space was prepared, scanned, and designed by using the exocad software program. Each reference design was used to fabricate PEEK post-and-cores with 3 different techniques (N=30): group P, heat pressing; group S, subtractive manufacturing, and group A, additive manufacturing. All the fabricated restorations were scanned, providing the test data as standard tessellation language (STL) files, which were imported with the reference data into a reverse engineering software program to evaluate the 3D trueness of each fabrication technique. To evaluate the intaglio fit, restorations coated with silicone material were scanned to provide the test data as STL files, which were superimposed on the STL files of the scanned restorations. One-way analysis of variance (ANOVA) and 2-way mixed model ANOVA tests were used to analyze the data (α=.05).

RESULTS

For 3D trueness, root mean square (RMS) values representing the deviations between the scans of the fabricated restorations and the reference designs varied significantly among different groups (P<.001), with the highest mean deviation found in group A (102.8 ±31 µm), while the lowest mean deviation was found in group S (42.2 ±11 µm). For the intaglio fit, the deviations between the scans of the fabricated restorations and the scans of the coated restorations varied significantly among different groups (P<.001), with the highest mean deviation found in group A (228.4 ±47 µm), while the lowest mean deviation was found in group S (96.2 ±14 µm). Simple effects comparisons showed the highest value of deviation in the apical area in group A (P<.001).

CONCLUSIONS

Custom-made PEEK post-and-cores fabricated by using subtractive manufacturing and heat pressing techniques showed better trueness and intaglio fit compared with additively manufactured restorations. Before printed PEEK restorations can be considered a suitable alternative to pressed or milled ones, improvements are required to confirm their reliability.

Evaluation of Internal Fit in Custom-Made Posts and Cores Fabricated with Fully Digital Versus Conventional Techniques

OBJECTIVE

This study aimed to assess and compare the internal fit of custom-made posts and cores fabricated using digital impressions (DI) and conventional vinyl polysiloxane (VPS) impressions in restorative dentistry.

MATERIALS AND METHODS

A typodont tooth model, simulating the anatomy of the root canal of a central incisor, was utilized for the study. Two groups were formed, Group A and Group B, and each group provided a total of 18 impressions of two types: DIs and VPS impressions. In Group A, posts and cores (PCs) were fabricated using Selective Laser Melting (SLM) from the DIs. Meanwhile, in Group B, conventionally cast (CC) PCs were created from the VPS impressions. Silicone replicas of the internal surfaces were produced, and measurements were made at seven different points for each group. A statistical analysis was performed to assess the differences in internal fit between the two impression techniques.

RESULTS

The results revealed a statistically significant difference in mean internal fit between Group A (DI and SLM) and Group B (VPS and CC), with Group A exhibiting a mean internal fit of 182.6 µm and Group B showing a mean of 205.9 µm. While both groups demonstrated considerable variability in internal fit measurements, the digital impression technique showed promise for achieving superior internal fit, with a significantly greater fit for measuring points on sides and the most apical part of the post for Group A. Variations were observed across different measuring points, emphasizing the impact of impression technique on specific regions within the tooth.

CONCLUSION

This study contributes to the growing body of knowledge in digital dentistry by highlighting the potential benefits of DIs in achieving a superior internal fit for custom-made PCs. Clinicians may consider the advantages of digital techniques to enhance the precision of their restorative procedures, although further research is warranted to evaluate the clinical impact of these findings.

The Accuracy of Custom-Made Milled Metal Posts as Compared to Conventional Cast Metal Posts

AIM

The aim of this study was to compare the fitting accuracy of custom-made metal posts and cores fabricated by half-digital and milling technique to that of conventional cast posts fabricated by direct technique.

METHODS

Sixteen extracted single-rooted teeth were endodontically treated followed by post space preparation. A direct resin post and core pattern was made for each tooth and used for the fabrication of two posts (n = 16). Each post resin pattern was digitized with a laboratory scanner and used for the fabrication of a milled cobalt-chrome (Co-Cr) alloy post, while the direct resin pattern, after scanning, was cast in a Co-Cr alloy to produce a cast post. Each post was seated on its respective tooth and evaluated using microcomputed tomography. The following variables were evaluated: total space volume between the post and root canal, the volume and distance of the apical gap between each post and the remaining apical root canal filling, as well as the distance and surface area of the space between the post and lateral root canal wall at four determined points along the length of each post.

RESULTS

The results revealed that half-digital and milled posts had a statistically significantly higher total space volume (p < 0.05), apical gap volume (p < 0.02) and distance (p < 0.02), as well as a higher surface area of space between the post and root canal wall at the cervical area as compared to the cast post (p < 0.05).

CONCLUSIONS

This study demonstrated that the fitting accuracy of cast posts was more accurate than posts fabricated with half-digital and milling technique.

Polyetheretherketone split post and core for restoration of multirooted molar with insufficient dental tissue remnants by digital techniques: a case report and 3-year follow up

BACKGROUND

Multi-rooted teeth with extensive dental defects often face challenges in stability and biomechanical failure. High-performance polymer PEEK materials, with properties closer to dentin, show promise in reducing stress concentration and preserving tooth structure. This report aimed to explore the use of a highly retentive polyetheretherketone (PEEK) for manufacturing custom-made split post and core for the restoration of grossly destroyed endodontically treated molars.

CLINICAL CONSIDERATIONS

A 40-year-old female patient presented with complaints of loss of tooth substance in the posterior mandibular tooth. This case involved the digital design and fabrication of PEEK split post and core to restore multirooted molar with insufficient dental tissue remnants. The restorations were evaluated over a 3-year follow-up using the World Federation criteria (FDI). The restoration was clinically evaluated through intraoral examination, radiographic assessment, and subjective patient satisfaction, and was deemed clinically good according to FDI criteria.

CONCLUSION

The outstanding mechanical properties of PEEK, coupled with the structure of the split post, provide an effective treatment option for weakened multirooted teeth. Simultaneously, the restoration configuration effectively addressed the challenge of varying postinsertion directions, and the interlocking mechanism between the primary and auxiliary posts enhanced the stability of the post and core.

The role of intraoral scanning in the fully digital workflow for post and core restorations: A scoping review

OBJECTIVE

This scoping review aimed to map the literature on the utilization of intraoral scanners (IOS) in fabricating post and core restorations.

DATA

The study protocol is available at https://osf.io/ja9xh/. This scoping review followed Joanna Briggs Institute guidelines, and reporting was based on the checklist proposed by PRISMA-ScR.

SOURCES

Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, and grey literature up to August 2023.

RESULTS

A total of 455 studies were identified. After screening, 16 studies were deemed suitable for scoping review. Of these, 13 were in vitro studies, two were case reports, and one was a clinical study. Different IOS systems for scanning post spaces were evaluated, with Trios being most prevalent, followed by Prismescan. While most studies did not use any intraoral scanning devices, five studies reported the use of scan posts. Results regarding retention favored fully digital workflows. However, results about the adaptation and accuracy varied between included studies, highlighting the importance of standardized approaches. Future clinical studies should encompass variations in IOS systems, post space depths, scanner depth of field, light conditions, scan post utilization, operator experience, scanning time and strategy, and direct comparison with conventional techniques.

CONCLUSION

IOS is increasingly important in capturing digital impressions for post spaces and provides valuable insights for clinicians and researchers. Although included studies, primarily in vitro, demonstrated promising results for the utilization of IOS systems in fully digital workflows for post and core restorations, further well-conducted studies, particularly clinical trials, are recommended due to data heterogeneity and limitations.

CLINICAL SIGNIFICANCE

This mapping highlights the potential of modern IOS in fully digital workflows for post and core restorations. Despite promising results, challenges related to different variables associated with IOS require careful consideration. Standardization and additional clinical validation are essential for optimize IOS benefits in post and core restorations.

Evaluation of custom posts and cores fabricated by two digital technologies in core and post space dimensions

PURPOSE

To evaluate the adaptability between posts and post spaces and the rationality of cores fabricated by two digital custom post-and-core processes.

MATERIALS AND METHODS

Titanium post-and-cores were fabricated by digital scanning impression technology or digital scanning wax-pattern technology on tooth defect molds of incisors, premolars, and molars, with traditional lost-wax casts of these teeth as the controls. Micro-CT and a laboratory scanner were used to determine intervals between post wall and root canal wall of the root apex, middle, and cervix of each sample in cross-, sagittal, and coronal sections; intervals between the end of post and tooth; diameters of cervical, middle, and incisal part at cross-, sagittal, and coronal sections of each sample, as well as shoulder widths.

RESULTS

The three fabrication processes showed significant differences in intervals between post-and-core prostheses and root canal walls, diameters of all parts of cores, and shoulder widths. Scanning impressions showed significant advantages in the main part of post-and-cores in incisors and premolars, while the scanning wax-pattern process showed obvious inferiorities in premolars and molars. As to core spatial size, values of measured sites in the scanning impression process were closer to the standard than those of the traditional process, while differences between the measured value of the scanning wax-pattern process were much more obvious than in the traditional process.

CONCLUSIONS

The use of digital custom post-and-core scanning impressions improved the rationality and precision of post-and-core dimensions compared with two other processes.

Assessment of CAD/CAM Fabrication Technologies for Post and Core Restorations-A Narrative Review

The primary objective of this study is to conduct a comprehensive review of the existing literature that discusses research on post and core restorations, covering aspects such as their composition, manufacturing methods, and clinical effectiveness. The methodology employed in this review encompasses the implementation of a well-defined search strategy, the establishment of criteria for inclusion and exclusion, and the selection of relevant studies to summarize their findings. To gather relevant literature published between 1993 and 2023, the research team conducted separate searches on PubMed, Web of Science, and Embase databases. In total, 168 titles were initially retrieved from these electronic databases. By applying the predefined exclusion criteria, the researchers identified 73 articles that specifically address the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) technologies employed in post and core restorations. These treatments are commonly employed to restore teeth that have received endodontic therapy and subsequently experienced loss of dental structure. The development of computerized technology for the creation of customized posts and cores has emerged as a straightforward and efficient alternative to traditional methods. The review synthesizes papers discussing the techniques and materials involved in CAD/CAM-based construction of post and cores. It explores strategies for restoring endodontically treated teeth, highlighting both direct and indirect approaches. Commonly mentioned materials include zirconia, composite resin, and hybrid ceramics. Despite the limited literature on CAD/CAM post and core procedures, the review emphasizes the necessity of further research to assess long-term outcomes and efficacy. Additionally, it suggests including implications for future research and clinical recommendations to enhance the depth and practical relevance of the review.

Bond strength of prefabricated and CAD-CAM milled glass fiber post-and-cores luted with conventional, universal, and self-adhesive composite resin cement

STATEMENT OF PROBLEM

Little is known about the effect of different composite resin cements on the bond strength of prefabricated and milled glass fiber post-and-cores.

PURPOSE

The purpose of this in vitro study was to compare the push-out bond strengths of root dentin and standard, relined, or computer-aided design and computer-aided manufacturing (CAD-CAM) glass fiber post-and-cores luted with conventional, universal, or self-adhesive composite resin cement.

MATERIAL AND METHODS

Post spaces were prepared in 90 premolars. Standard and relined prefabricated and CAD-CAM-milled glass fiber post-and-cores were luted with conventional (RelyX ARC; 3M ESPE), universal (RelyX Ultimate; 3M ESPE), and self-adhesive (RelyX U200; 3M ESPE) composite resin cement (n=10). All specimens were thermally aged (5000 cycles at 5°C and 55°C with a 20-second dwell time) and mechanical fatigue (1 000 000 cycles at 2 Hz, 50-N load). The specimens were sectioned perpendicularly to the root long axis into 1-mm-thick sections (apical, middle, and cervical root thirds), the push-out bond strength was determined, and the mode of failure recorded. Data were submitted to the Kruskal-Wallis test followed by the Bonferroni-Dunn multiple comparison test (α=.05).

RESULTS

Push-out bond strength values did not differ (P>.05) among posts at the same root thirds. Standard posts showed higher bond strength than CAD-CAM at the apical third for data grouped by composite resin cements (P<.001). The cervical root thirds had higher bond strength than the apical thirds (P<.05). The cervical, middle, and apical root thirds showed decreasing bond strength values for each type of post for data grouped by composite resin cement (P<.001). Adhesive failures at the dentin-cement interface were predominant.

CONCLUSIONS

The type of posts and cements did not affect the bond strength of glass fiber posts. The cervical root thirds had better bonding performance than the apical thirds.

'Gold' lost in restoration: Evaluation of core morphology of custom metal posts and cores, and analysis of precious metal debris

1 Objectives

To investigate the deviations between the morphological dimensions of finished cores and desired dimensions made by three available fabricating techniques. To assess the precious metal loss in custom precious metal post and core restorative treatment in the dental clinic.

2 Methods

Titanium posts and cores were fabricated using three different techniques: digital scanning impression technology, digital scanning wax-pattern technology, and the traditional lost-wax casting method. Geomagic Studio was used to fit the scanned model data to the digital design data of the expected preparation and to analyze the 3D deviations between the two. Precious metal debris from the precious metal post and core was collected, processed, weighed and analyzed for precious metal elements by energy-dispersive X-ray spectroscopy layered images.

3 Results

In all 48 pairs of models, there were positive and negative deviations, with the largest mean positive deviation of (0.752 ± 0.037 mm) for models made by the semi-digital scanning wax-pattern technique. A total of 7001.3 mg of metals was recovered from the waste streams collected, which contained precious metals-mainly gold, silver, and platinum.

4 Conclusions

There were discrepancies between the custom core and the expected preparation regardless of the fabrication process used. The digital scanning impression technology showed better dimensional rationality of crown cores. Custom precious metal posts and cores can have an average precious metal loss of 129.7 mg per case in the dental clinic.

Scientific mapping of hotspots and trends of post and core research based on the Web of Science: A bibliometric analysis

Statement of problem

Post and core (PC) restoration has been widely used to restore endodontically treated teeth. Nevertheless, bibliometric studies focusing on PC research are lacking.

Purpose

The purpose of this bibliometric analysis was to review the general situation and determine the research direction of PC restoration by means of visualization, including the time development, countries, institutions, authors, journals, research categories, and the information of references with the strongest citation burst.

Material and methods

The search was carried out within the topic field of the Web of Science (WoS) database. CiteSpace, VOSviewer, and R language were used to analyze the literature. Bibliometric indicators in terms of title, keyword, reference, publication time, institution, country and citation information were analyzed.

Results

Between 1966 and 2022, dental research on PC trended upward, especially in 2011 and up to 2022. Scholars in Brazil, the United States, and Italy actively participated in PC research. The country that published the most was Brazil. Italy both ranked first in the H-index and average citations per item and had cooperative relations with several countries. The United States ranked first in the world in total citation count. The University of Siena published the most articles. The Journal of Prosthetic Dentistry (JPD) was the major contributing journal. The top three authors in this field were Ferrari M, Goracci C and Naumann M. The largest cooperative network of authors consisted of four Italian scholars. There were six main clusters of research topics on PC through CiteSpace co-citations. In addition, CiteSpace co-citations, CiteSpace Burst detection and VOSviewer keyword analysis showed the most important research interests, such as bond strength, fiber post, fracture resistance, and finite element analysis. Photodynamic therapy is the latest research hotspot. Finally, there were the top 25 references with the strongest citation bursts, which mainly focused on four aspects, namely, studies related to fiber posts, PC bonding strength, finite element analysis, and residual teeth and the ferrule effect.

Conclusions

This bibliometric analysis provides a comprehensive overview of PC research, including the research time, country, institution, author, journal, article clustering, article keywords, and important literature analysis, so that researchers can have a clear understanding of the research situation in this field.

Internal adaptation and mechanical properties of CAD/CAM glass fiber post-cores in molars: An in vitro study

OBJECTIVE

The purpose of this in vitro study was to evaluate the internal adaptation, fracture resistance, and fracture pattern of the residual roots and crowns of molars restored with computer-aided design/computer-aided manufacturing (CAD/CAM) glass fiber post-cores, and compare them with three other post-core restorations.

MATERIALS AND METHODS

We selected 32 extracted maxillary first molars and divided them into four groups according to the post-core system: traditional casting titanium (Ti) post-cores (TC group); Ti post-cores fabricated with selective laser melting (SLM group); CAD/CAM glass fiber post-cores of the split type (CCS group); and prefabricated glass fiber posts and composite resin cores (PF group). The internal adaptation was analyzed with microcomputed tomography. Teeth were restored with monolithic zirconia crowns and subjected to thermocycling and cyclic loading. A load was applied consistently along the long axis of the tooth until fracture to record the fracture resistance and pattern. For the statistical analysis, one- and two-way analyses of variance, Tukey's post hoc and chi-square tests were performed to compare the differences among the groups.

RESULTS

The CCS, TC, and SLM groups exhibited similar internal adaptations across all sections (P < 0.05). The FP group showed good fit with the root canals in the apical and middle sections but a poor fit with those in the cervical section. The fracture resistance was higher in the CCS, TC, and SLM groups compared to the PF group (P < 0.05). The proportions of restorable fractures in the CCS and PF groups were 62.5% and 50%, respectively. Unrestorable fractures were more frequent in the TC and SLM groups at frequencies of 100% and 87.5%, respectively.

CONCLUSION

The internal adaptation and fracture resistance of the CCS group were similar to those of the TC and SLM groups, and the fracture pattern was mostly restorable, thus meeting the clinical requirements for molar post-core restorations.

CLINICAL SIGNIFICANCE

CCS can be used to restore residual roots and crowns of molars and exhibit high efficacy in terms of adaptability and mechanical properties. More studies are required to evaluate the effectiveness of CCS.

The impact of print orientation on the fracture resistance and failure patterns of additively manufactured cobalt-chromium post and cores

PURPOSE

The aim of this study was to evaluate the impact of the print orientation of direct metal laser sintering (DMLS) posts and cores on the fracture resistance and failure patterns of endodontically treated mandibular premolar teeth.

MATERIALS AND METHODS

Sixty intact human mandibular premolars were endodontically treated. The teeth were then randomly divided into four groups (n = 15). Cobalt-chromium (Co-Cr) metal posts were fabricated by traditional casting (Group C), and DMLS method in 0-, 45-, and 90-degree print orientations (Group DMLS 0, Group DMLS 45, and Group DMLS 90). The posts and cores were cemented with composite resin cement and subjected to compression test at a crosshead speed of 1 mm/min. Data was analyzed by using one-way analysis of variance ANOVA and multiple comparison post hoc Tukey tests (α = 0.05). Specimens were viewed under a stereo microscope with x20 magnification to evaluate the fracture types.

RESULTS

No significant differences were found among the groups tested in terms of fracture resistance (p > 0.05). Group C and Group DMLS 0 group exhibited similar fracture patterns.

CONCLUSIONS

It is possible to produce post and core restorations with the DMLS technique and use them clinically.  Print orientation did not influence the fracture resistance. However, fracture patterns were different. Group C outperformed all DMLS groups in terms of fracture patterns.

Influence of alveolar bone height on the biomechanical behavior of roots restored with custom-made posts-and-cores

OBJETIVE

This study evaluated the influence of alveolar bone height and post type on compressive force resistance, fracture pattern, and stress distribution in endodontically treated teeth.

MATERIALS AND METHODS

Bovine roots were endodontically treated and divided into eight groups (n = 10) according to alveolar bone height (normal alveolar bone and alveolar bone loss - 2 and 5 mm from the margin of the crown, respectively) and post type (prefabricated glass fiber post, anatomic glass fiber post, customized milled glass fiber post-and-core and customized milled polyetheretherketone (PEEK) post-and-core). Mechanical fatigue was simulated (300.000 cycles/50 N/1.2 Hz). Compression force resistance (N) was analyzed by two-way ANOVA and Tukey test (α = 0.05). Fracture patterns were described as percentages. Stress distribution was analyzed by finite element analysis.

RESULTS

Significant diferences were found for alveolar bone height (P < 0.0001): normal alveolar bone groups showed higher mean values of compression force resistance compared to alveolar bone loss groups, while no significant differences were found for post type (P = 0.4551), and there was no double interaction between them (P = 0.5837). Reparable fractures were more predominant in normal alveolar bone groups, especially in the milled glass fiber and PEEK post-and-core groups. Stress distribution was similar in groups with prefabricated glass fiber posts and milled PEEK posts-and-cores, and the alveolar bone loss condition significantly increased stress concentration and strain values, mainly on apical dentin.

CONCLUSIONS

Alveolar bone loss due to physiological aging and/or periodontal disease may lead to increased risk of restored tooth failure, although milled glass fiber and PEEK posts-and-cores provide more reparable fractures.

CLINICAL SIGNIFICANCE

Custom-made glass fiber and PEEK post-and-cores are interesting options, since they enable clinicians to work with a single-body post-and-core system that avoid several materials interfaces and fits well in the root canal provided promising results to improve the failure behavior of restored roots, as they offer more reparable fractures even in situations of alveolar bone loss.

Compressive Strength and Porosity Evaluation of Innovative Bidirectional Spiral Winding Fiber Reinforced Composites

The aim of this in vitro study was to investigate the compressive strength and the bulk porosity of a bidirectional (bFRC) and an experimental bidirectional spiral winding reinforced fiber composite (bswFRC). Cylindrical-shape specimens were prepared for each material group and processed for the evaluation of compressive strength after different storage conditions (dry, 1 and 3 months) in distilled water at 37 °C. The specimens were also assessed for the degree of bulk porosity through X-ray tomography. A scanning electron microscope (SEM) was used to determine the fracture mode after a compressive strength test. Data were statistically analyzed using Two-Way Analysis of Variance (ANOVA). A significantly lower compressive strength was obtained in dry conditions, and after 1 month of water immersion, with the specimens created with bFRC compared to those made with bswFRC (p < 0.05). No significant difference (p > 0.05) was found between the two groups after 3 months of water immersion. However, the presence of water jeopardized significantly the compressive strength of bswFRC after water storage. The type of fracture was clearly different between the two groups; bswFRC showed a brutal fracture, whilst bFRC demonstrated a shear fracture. The bswFRC demonstrated higher pore volume density than bFRC. In conclusion, bswFRC is characterized by greater compressive strength compared to bFRC in dry conditions, but water-aging can significantly decrease the mechanical properties of such an innovative FRC. Therefore, both the novel bidirectional spiral winding reinforced fiber composites (bswFRC) and the bidirectional fiber reinforced composites (bFRC) might represent suitable materials for the production of post-and-core systems via CAD/CAM technology. These findings suggest that both FRC materials have the potential to strengthen the endodontically treated teeth.

Fracture strength, pull-out bond strength, and volume of luting agent of tooth-colored CAD-CAM post-and-cores

STATEMENT OF PROBLEM

Little is known about the fracture strength, retention, and adaptation of post-and-cores fabricated with novel tooth-colored materials by computer-aided design and computer-aided manufacturing (CAD-CAM).

PURPOSE

The purpose of this in vitro study was to investigate the fracture strength, pull-out bond strength (POBS), and volume of luting agent of endodontically treated premolars restored with post-and-cores milled from different CAD-CAM materials.

MATERIAL AND METHODS

Post spaces were prepared in 80 human premolars in which post-and-cores fabricated with polyetheretherketone (PK; Ceramill PEEK), nanohybrid composite resin (BB; Brava Block), polymer-infiltrated ceramic (EN; VITA Enamic), and fiber-reinforced epoxy resin (GF; Fiber Cad Post & Core) CAD-CAM materials were luted (n=20). All specimens were subjected to thermal aging (3000 cycles at 5 °C and 55 °C with a 20-second dwell time). Half of the specimens were subjected to mechanical fatigue (250 000 cycles at 5 Hz) before fracture strength testing, while the other half was submitted to POBS testing and volume of luting agent measurement. Fracture strength data were analyzed by 1-way ANOVA, while POBS and volume of luting agent data were submitted to Kruskal-Wallis followed by the Bonferroni-Dunn multiple comparison tests. The correlation between POBS and the volume of luting agent was determined by the Spearman test (α=.05).

RESULTS

POBS of GF was significantly higher than that for PK (P<.001); however, failure load (P=.160) and volume of luting agent (P=.390) values did not differ. EN showed the highest percentage of catastrophic failures (20%), while PK exhibited only core deformations. POBS and cement film volume were not significantly correlated (P>.05).

CONCLUSIONS

Different CAD-CAM materials did not influence the fracture strength and volume of luting agent of post-and-cores. Post-and-cores made with PEEK blocks showed lower bond strength to intracanal dentin than those made with fiber-reinforced epoxy resin blocks. No significant correlation was found between bond strength and the volume of luting agent.

Customized Post and Cores Fabricated with CAD/CAM Technology: A Literature Review

Post and core restorations are a widely accepted method to restore endodontically treated teeth with compromised tooth structure. The use of computerized technology to fabricate customized post and cores is a simple and quick alternative to conventional methods. A literature search was conducted, and a summary of articles describing fabrication techniques and materials used to fabricate post and cores with computer-aided design and computer-aided manufacturing (CAD/CAM) has been provided. Several techniques have been reported to restore endodontically treated teeth with CAD/CAM post and cores, including direct and indirect methods. Zirconia, composite resin, and hybrid ceramic were the most commonly reported materials. Published reports on CAD/CAM post and core are limited; however, further studies are needed to investigate the long-term outcome of this treatment.

Fabricated CAD/CAM Post-Core Using Glass Fiber-Reinforced Resin Shows Innovative Potential in Restoring Pulpless Teeth

The prevention of root fractures of pulpless teeth is an important clinical issue to maintain healthy teeth through lifetime. The aim of this study was to examine a clinically effective treatment method for strengthening vulnerable pulpless teeth using CAD/CAM (computer-aided design/computer-aided manufacturing) fiber-reinforced post-core by conducting a fracture resistance test. A post-core made with a fiber-reinforced resin disk TRINIA (TR, SHOFU, Kyoto, Japan) was fabricated using a CAD/CAM system. The fiber-layer orientation of the CAD/CAM post-core was parallel to the axis of the restored tooth. A post-core using a conventional composite and a fiber post (CF) was also prepared. A fracture resistance test of teeth restored with the post-cores and zirconia crowns was conducted using a universal testing machine, and fracture patterns were identified by micro-CT observation. The fracture load of the roots restored with TR was 1555.9 ± 231.8 N, whereas that of CF was 1082.1 ± 226.7 N. The fracture load of TR was 43.8% that was significantly higher than that of CF (Student's t-test, p < 0.05). The restored teeth with CAD/CAM resin post-core were found to be repairable even after fracture. These results suggest that the CAD/CAM indirect fiber post-core has the potential to strengthen the vulnerable pulpless teeth.