Fracture Resistance of Endodonticallv Treated

Teeth Restored with Three Different Prefabricated

Esthetic Posts
PAUL0 C . A . .MA<:CARI, DDS. IMS"
EWERTON N . CONCEICAO. DDS, MS. P I I D +
.MAURO F . NUNES. DDS, .MS'

ABSTRACT

Purpose: This study was undertaken to evaluate the role of composition of prefabricated esthetic
posts in fracture resistance of endodontically treated teeth in vitro.
Materials and Methods: Thirty human, single-rooted teeth (maxillary central incisors and canines)
with similar root dimensions, extracted for therapeutic reasons, were used in this study. The crowns
were removed below the cementoenamel junction to obtain a standard root length of 17 mm.
The roots were endodontically treated following the conventional manual technique and randomly
assigned to three groups (n = 10) according to the post used: Aestheti-Post, Aisco, Schaumberg,
Illinois; FibreKor Post, Jeneric/Pentron,. Wallingford, Connecticut; and CosmoPost, Ivoclar
Vivadent, Schaan, Liechtenstein. The root canals were rendered patent, and the root preparations
were standardized through flaring with the manufacturers' drills included in the respective kits.
The posts were cemented with an adhesive system and a resin cement (All-Bond 2 and
C&B, Bisco, respectively), according to the manufacturers' directions. Composite resin (Tetric
Ceram, Ivoclar Vivadent) crowns were built up using a preformed polyester matrix, and the
specimens were mounted in metallic rings with cold-cure acrylic resin and kept in saline solution
at 4C for 24 hours. Fracture resistance was then determined using an EMIC DL-2000 universal
testing machine. The crosshead speed was 0.5 m d m i n with the 45-degree compressing load at
the middle third of the crown. Data were analyzed using one-way analysis of variance and
Tukey's test ( p 5 .OOl).
Results: Mean fracture resistance was as follows: Aestheti-Post, 83.5 kgf; FibreKor Post, 85.7 kgf;
and CosmoPost, 36.5 kgf. The fracture strength of CosmoPost was significantly lower than that
of the other posts. Teeth restored with CosmoPost had post fractures, and in three specimens,
those were associated with root fractures. Teeth restored with the other two posts presented
fractures on the composite crowns.
CLINICAL SIGNIFICANCE

Compared with ceramic posts, carbon-fiber and glass-fiber prefabricated esthetic posts provide
endodontically treated teeth higher fracture resistance.
Esthet Restor Dent 1525-3 1,2003)

5Assistarit Professor and Graduate Program Director, Division of Operative Dentistry. Departrneitt vf
Prvsthodontics, Pontifical Catholic University of Rio Graride do Sul Sclx)ol of Dentistry. Porto Alegre. RS.
Brazil
'Associate Professor, Division of Prosthodontics,Departnient of Prosthodontics, Pontifical Catholic University
of Rio Grarrde do Sir1 School of Dentistry, Porto Alegre, RS. Brazil
tAdjirnct Instructor of the Operatiue Deritistry Residency Progranr, Department of Conservatiiw Dentistry.
Federal University of Rio Graride do Sul Sckool of Dentistry, Porto Alegre, RS, Brazil

V O L U M E 1 5 . N U M B E R I , 200.3

25

FRACTVRE RESISTAYCE O F ESDODONTICALLY TREATED T E E T H RESTORED

WITH THREE DIFFERENT PREFABICATED ESTHETIC POSTS

ollowing root canal treatment,

the tooth becomes weaker
because sound 200th structure has
been removed to properly manage
the pulp tissue and clean the root
cana1.l It is well known that the use
of posts to restore endodontically
treated teeth does not increase the
strength of the remaining tooth.
Posts only provide retention to the
restoration^.^,^ It is challenging for
the dentist to restore an endodontically treated tooth. Many restorative alternatives are available, and it
can be difficult to choose the best
treatment to achieve longevity.
Cast post and core has been widely
used to reestablish the dental structures lost during endodontic treatment. In spite of its popularity, the
cast post and core restoration has
some disadvantages that may jeopardize long-term success. Disadvantages mentioned in the literature
include tooth weakness related to
the removal of root structure to
accommodate the necessary post
length, lack of cement retention,
corrosion risks, poor stress distribution leading to root fracture, difficulties in removal of the post,
necessity for two appointments to
complete the procedure, and laboratory C O S ~ S . ~ ~
According to Duret and colleagues,
an ideal post should have similar
shape to the lost dentin volume (the
prepared root canal) and mechanical properties identical to the dentin
to provide long-lasting bonding.

26

The post should not induce tension

while being set, and minimal root
canal preparation should be done
to fit the post.6 The same authors
also stated that posts of a light shade
would improve the final esthetic
result in some clinical situations.6
Conceisdo suggested some clinical
characteristics required for posts
and emphasized the advantages of
posts that are prefabricated and
esthetic. The purpose of this study
was to evaluate the role of composition of prefabricated esthetic posts
in fracture resistance of endodontically treated teeth in vitro. The null
hypothesis was that the composition of prefabricated esthetic posts
does not affect fracture resistance
of endodontically treated teeth.
MATERIALS A N D M E T H O D S

Thirty extracted, noncarious, intact

human maxillary central incisors
and canines were cleaned and
stored in saline solution at 4C.
The teeth were examined at four
times magnification, and those with
crazing present were excluded from
the study. Selected teeth were then
sectioned below the cementoenamel
junction (CEJ) with a cone-shaped
diamond (No. 3203, KG Sorensen,
SZo Paulo, SP, Brazil) at high speed
under water cooling to a standard
root length to 17 mm. A caliper
(Tastmeter, Girrbach Dental Systems,
Pforzheim, Germany) was used to
select teeth with the following
dimensions: 5.0 to 5.5 mm mesiodistal and 7.0 to 8.0 mm facio-

JOURNAL OF ESTHETIC A N D RESTORATIVE DENTISTRY

lingual. Teeth with excessively

wide or constricted root canals or
dilacerations at the apex also
were excluded.
The roots were endodontically
treated following the conventional
manual technique (No. 40 file,
K-Flexofile, Dentsply DeTray,
Konstanz, Germany) with no
instrumentation within 1 mm of
the apex. Irrigation was done with
1% sodium hypochloride. After
instrumentation, the roots were
dried using high vacuum aspiration
and No. 40 paper cones (Dentsply
DeTrey) and then filled with No. 40
gutta-percha cones (Dentsply
DeTrey) and eugenol-free cement
(Sealer 26, Dentsply Caulk,
Milford, Delaware, USA). Thermomechanical condensation was done
by means of the MacSpadden
device (Moyco Union Broach, York,
Pennsylvania, USA). The endodontic accesses were sealed using the
conventional glass ionomer
Ketac-Bond (ESPE Dental-Medizin,
Seefeld, Germany), and the roots
were stored in saline solution at
4C for 48 hours.
The 30 endodontically treated roots
were randomly assigned to three
groups (n = 10) according to post
used:
1. Group AP: Aestheti-Post (Bisco,
Schahmburg, Illinois, USA),
1.4 mm diameter
2. Group FK: FibreKor Post
(Jeneric/Pentron, Wallingford,

MACCARI ET A L

TABLE 1

C O M P O S I T I O N OF T H E P R E F A B R I C A T E D E S T H E T I C P O S T S

Post

Aesthki-Post
CosmoPost
FibreKor Post

Manufacturer

Composition

Bisco Inc.
IvoclarNivadent
JeneridPentron

Carbon fiber, epoxy resin, quartz

Zirconium-dioxide
Glass fiber, resin matrix (Bis-GMA, HDDMA, UDMA, DEAMA,BHT, TFO),
barium sulfate, barium silicate

Connecticut, USA), 1.5 mm

diameter
3. Group CP: CosmoPost (Ivoclar
Vivadent, Schaan, Liechtenstein), 1.4 mm diameter

rinsed with water spray for 30 seconds and also with a regular 50 mL
syringe and tap water. Paper cones
(Dentsply DeTrey) were used to
blot dry the root canal. After that,
five consecutivecoats of mixed
The composition of the posts is pre- Primer A and B (Bisco, Inc) were
sented in Table 1.
brushed on the intracanal and cervical dentin with a disposable brush.
A round-shaped diamond (No. 1012, The primer was then dried with
KG Sorensen) was used to remove
paper cones and a stream of air for
the endodontic access seal. A No. 2 15 seconds at a distance of 10 cm
Peeso Reamer (Moyco Union
from the endodontic access and
Broach) was used to remove 11 mm light-cured for 30 seconds with an
of gutta-percha, and to ensure a
Optilight curing light (Gnatus,
good seal, 5 mm was kept in the
RibeirZo Preto, SP, BraziI). The
apex.8 The root preparations were
intensity of the light was monitored
standardized through flaring with
with a curing radiometer, and it was
the manufacturers drills included
in excess of 400 mW/cm2 throughout
in the respective kits. The prepared
the study. After that, the Pre-Bond
canals were water-sprayed and
(Bisco, Inc) was applied in the canal
dried with paper cones.
and air dried for 15 seconds with
the syringe tip 10 cm from the
The length of the posts was stanendodontic access, and it was not
dardized to 17 mm by cutting the
light-cured. Primer B was applied
top with a diamond bur (No. 3203, on Aestheti-Post and FibreKor Post
KG Sorensen) under water-cooling.
and gently dried for 15 seconds.
The posts were cemented with
CosmoPost was not primed.
All-Bond 2 adhesive system (Bisco)
and C&B resin cement (Bisco)
Equal measures of C&B catalyst
according to the manufacturers
and base pastes were hand mixed
recommendations. The canals were
for 30 seconds. The mixed resin
acid etched for 15 seconds and
cement was carried into the root

canal by means of a Lentulo paste

fiIler in low speed rotation. The .
posts were inserted into the canals
and seated with finger pressure.
Excess resin cement was removed
with an explorer and a disposable
brush. The cement was then lightcured for 40 seconds with the light
tip touching the coronal post tip.
The crown portion was built up
with Tetric Ceram composite shade
Al. Thirty polyester canine-shaped
matrices (7 mm high) were previously made, filled with the composite, seated over the posts crown
portion, and light-cured for 40 seconds in four different directions
(facial, lingual, mesial, and distal).
The preformed polyester matrix was
then removed with a surgical blade.
The specimens were mounted in
metallic rings with cold-cure acrylic
resin. The roots were centered and
the cervical 2 mm was not covered
by the acrylic. The specimens were
kept in saline solution at 4C for
24 hours, and the fracture resistance
was then determined using an EMIC
DL-2000 universal testing machine.
The crosshead speed was 0.5 mm/
min with the 45-degree compress-

V O L U M E 1 5 , N U M B E R 1, 2 0 0 3

27

I.'II 4 (:Tl'R E H E:S I S T I N ( : 1- 0 F E N D 0 I) 0 X T I ( : I. I. 1- TRT: .\Ti1) T E E T I I R E STORE: I)

W I 'I'I I TI I R E E 1) I F ' F E R E N 'I' P R E F - . i B I C: A T E D E S'I'I-I I.:T I ( : P 0 S'I'S
L\

ing load at the lingual middle third

of the crown. After the test, the
specimens were classified according
to the fracture mode found: root
and composite fracture; post, root,
and composite fracture; post and
composite fracture; composite fracture. Mean fracture strength (kgf)
was analyzed using one-way analysis of variance (ANOVA) and
Tukey's test ( p I .001).
RESULTS

The results are summarized in

Table 2. One-way ANOVA revealed
a significant difference between
pairs of means ( p < .001). The post
hoc Tukey's test ranked the means
in two different subsets at p < .001.
CosmoPost had significantly lower
mean fracture strength than the
other posts ( p < .001). The means
for Aestheti-Post and FibreKor Post
were not significantly different from
each other, despite the slightly
higher results of FibreKor Post.
The fracture modes were different
for each post tested (see Table 2).
With Aestheti-Post, 90% of the
fractures occurred on the composite
crown and 10% were mixed frac-

tures of root and composite crown.

With FibreKor Post, all fractures
(100%) occurred on the composite
crown. With CosmoPost, 30% of
fractures were a combination of post,
root, and composite crown fractures
and 70% were a combination of
post and composite crown fractures.
DISCUSSION

Several factors play an important

role in proper selection of a prefabricated esthetic post: biomechanical
and physical properties, shape,
esthetics, cost, technique sensitivity.
There are in the market a variety of
posts with different composition
that meet the requirements for these
factors. This study examined the
biomechanical behavior of three
different prefabricated esthetic posts.
Meaningful comparison with results
of other similar studies of in vitro
fracture resistance is impossible
because of the number of variables
involved. Such variables include
tooth conditions previous to the
extraction, tooth age, tooth storage
conditions, pulp situation at the
time of extraction, root anatomy
and dimensions, and loading angle

and location. Besides, the prefabricated esthetic posts are new on the
market, and there is a lack of literature on them. Special attention to
standardize the methodology is
important to reduce the variability
among investigations. A 45-degree
loading was applied on the middle
facial third of the crown to simulate
the average functional angle of
normal occlusion. That methodology has also been used by other
researcher^.^-'^ In the present
research, the authors took particular care to standardize the root
dimensions, which has not been
related in analogous studies.
CosmoPost had a statistically significant lower mean fracture
strength than Fibrekor Post and
Aestheti-Post. The fracture analysis
was helpful to elucidate that finding
(see Table 2).
With Fibrekor Post, all fractures
occurred on the composite crowns;
no fractures occurred in these glassfiber posts. Burgess and Xu also
found the glass-fiber post to be
highly resistant and esthetic." It
has the ability to absorb and dis-

TABLE 2. M E A N FRACTURE STRENGTHS A N D FRACTURE M O D E S

Mean Fracture Strength

Posts

AP: Aestheti-Post
FK: FibreKor Post
CP: CosmoPost

( k M:
SO (n)*

Root + Composite

83.5 2 26.7 (10)"

85.7 * 17.7 (lo)*

l(lOO/,)

36.5 2 16.6

*Means with same superscript are not statistically different (p 5.001).

28

J O U R N A L OF E S T H E T I C A N D R E S T O R A T I V E D E N T I S T R Y

Fracture Moden
Post + Root + Composite Post + hpooit.

3 (30%)

7 (70%)

Cornpodto

9 (9oYo)
10 (100%)

tribute stress, which may explain

the absence of root and post fractures.'* This is interesting from a
clinical point of view because an
eventual composite foundation
fracture is clinically more easily
repaired than a root or post fracture. Fibrekor Post is a parallel post
different from the other two prefabricated posts tested in the present
study. It has been reported that zinc
phosphate-cemented parallel posts
have better retention and stress distribution than tapered posts.2 On
the other hand, a parallel post needs
more root preparation to fit properly,
which results in more loss of sound
tooth structure, a weak root, and,
consequently, a higher risk of root
f r a c t ~ r e . Therefore,
'~
it is extremely
important to evaluate the root canal
shape, tooth position, and occlusal
stress t o select the correct post.
Another potential advantage of
the glass-fiber posts would be the
capability of glass particles to conduct light, which may improve
polymerization of the resin cement.
Some authors have reported that
the root canal light transmission
may exceed 11 mm for the plastic
Luminex post (Dentatus USA Ltd.,
New York, New York, USA).20-22
However, more research is necessary in that field.
With the carbon-quartz prefabricated posts, Aestheti-Post, 90% of
fractures occurred in the resin crown
and 10% were mixed root and
resin crown fractures. Other studies

also have concluded that the majority of fractures occur in the resin
crown. The carbon-fiber posts absorb
and distribute the stress generated
by the foundation.','
Findings of the present study are in
agreement with those of Sidoli and
co-workers, who tested the fracture
resistance of carbon-fiber posts and
found a high percentage of foundation failure, which is less complicated
t o repair in clinical condition^.^^
1312,14,23724

The majority of the research

reported in the current literature
has tested conventional carbonfiber posts (C-Post, Bisco) and not
the carbon-quartz fiber posts used
in the present study. These posts
have recently been introduced in
the market. They are more esthetic,
stronger, and more resilient than
the conventional carbon-fiber
post^.^^?^^ Mannocci and colleagues
compared the in vitro fatigue fracture resistance of teeth restored
with all-ceramic crowns with three
different posts: quartz-fiber posts
( Aesthiti-Plus, Bisco), quartz-carbon
fiber posts (Aestheti-Post, Bisco),
and ceramic posts (Cerapost,
Komet, Milan, Italy).26They found
one root and post fracture in each
of the fiber post groups and one
crown fracture and five root and
post fractures in the ceramic post
group. Those results are in agreement with findings in the present
study in which similar fractures
were noted with the zirconiumdioxide ceramic posts (CosmoPost).

The CosmoPost group had seven

post and resin crown fractures and
three post, root, and resin crown
fractures. Those results are in
agreement with the literature that
says ceramic posts are too rigid and
transmit more stress to the root
canal than the fiber posts, which
leads to irreversible root damage.11,14,2s,27
In the present study,
all zirconium-dioxide posts fractured, which is a clinical disadvantage considering how difficult it
would be to remove a ceramic post
to place a new one to remake the
indirect restoration.
According to the manufacturers'
data, the modulus of elasticity for
prefabricated esthetic posts is
40 GPa for glass-fiber posts,
120 GPa for carbon-fiber posts,
and 170 GPa for zirconium-dioxide
posts. Considering that the modulus
of elasticity of dentin is 18.6 GPa, it
could be concluded that zirconiumdioxide posts differ most in
mechanical behavior when compared with the dentin. Zirconiumdioxide posts have a clinical behavior
more similar to steel prefabricated
posts, which have a modulus of
ulasticity of 210 GPa.
CONCLUSIONS

The null hypothesis was rejected

because the composition of prefabricated esthetic posts did affect the
fracture resistance of endodontically treated teeth. Under the
extreme conditions of this study, it
could be stated that teeth restored

VO1.UME IS, N U M B E R I , 2003

29

FRACTI'RE RESIYTAS(:E OF ESDODOSTI(:ALLY TREATED T E E T H RESTORED

U I T I I TllREE DIFFEREST PREFABICATED ESTllETlC POSTS

with ceramic posts had less than

half of the fracture resistance seen
in glass-fiber and carbonquartz
fiber posts. Moreover, the mode
of fracnve i n d in zirconiumdioxide posts was the type most
difficult to repair clinidly. Prefabricated esthetic posts with fiber in
their basic composition may be the
market trend.
DISCLOSURE AND
ACKNOWLEDGMENTS

Ceramodental (Southern-Brazil
Bisco Co. division)provided materials for this project. The authors
have no financial interest in any of
the companies or products mentioned in this article.
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12. Dean JP,Janronne BC, Sulur N. In vitro

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evalurtionofacarbon fiber-bucdpon
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L,Rilo N,
S.ntanaU.Compuioonof~frscnvc
rairtpwaofpdpkss teeth r a & d with
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with 8 compoaitc C0rr.J Rosrhct b t
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14. AmnurmE,pnraMdt~HeimunnT.
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h4qhwim Ligurc, Italy, March 26-27,
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25. RovattiL,MuuonPN,DallariA.Thc
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15. DrwnmadJL, T q k e TR, KingTJ.

-rhcmal and cyclic loadiag of mdodontic
posts. Eur J Oral Sci 1999,10722&224.

26. Mannocci F, Femri M, Watum T. Intermimntl*ofaccrhnaffnad*

quprez fiber, arboaquarafiber, and
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JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY

WACCAR'I

El' A L

COMMENTARY
FRACTURE RESISTANCE OF ENDODONTICALLY TREATED TEETH
RESTORED WITH THREE DIFFERENT PREFABICATED ESTHETIC POSTS

Raymond L. Bermlotti, DDS,PhD*

By mcasuringthe fracnucnsistonce and fracture mode of aeth restored with three esthetic posts, the authors have contributed important dinicpl informationto aid the cliniciru, in the selection of an appropriate esdvtic post.
Therearemany dderationswhenchoogineapost. Animportant oneis the failure mode to beexpected from the
combination of post, core,and crown. Thepresent article saollglymggescsthatthere =major differmcesin fracnuv
howevg crowns were nor placed over the compositecore, so that leaves some doubt as to whether the fracture
mode f o r d tccthcanb e c o d y predicted from the prcsentresults.

Postremovrrlisa major ClinicalprobIan in the ewnt of failure. The authors did not address that issue, but cIinical
acpcl.ience has shown that bonded, solid zirconia (kconiumdioxide)posts are difficult to remove. When coupled with
the current results of adverse root hctuces and less froaurrresistpncc than the fiba posts have, the clinicaldisadvantagesof zkconia posts become apparent.
From the elastic properties, quoted by the authors, we mightd u d e that posts with very high elastic moduli should
be avoided. Howeva;rlinicnl cxperihas shownthat poas with very low d u l i lead to another problaq in the
absenceofadmtamal
*
"fcmIW"'thctoothsauaure, thelow-moddipostslead to debonds of crowns where they
are bodedto the minimal fade. Ramtion of the crown on the core is gemrally not a problem.
It seems that che ideplpost should have an ektk modulus in the middle rpnec--perhapea bit higher than that of tooth
sauaurc (mogdydcntin)toca.rrysomeloadand h l p prevent debondsinthe fermle area. In theroocsomesortof stress
dissipation seems appropriate. A taped-post design wodd achieve the objective of stress dissipation, even in the presaceof a relativclyhighektkmoddus.Anisoaopicmoddiwouldbe anorher approach tothe design of ideal posts.

Wd all the confounding factors involved,it is dear that diaicalexperience is neededto assess the long-termsuccess of
posts. The current authors have mode an importantconaibutioata-

future clinical trials.

I
"Priuate Practice, Clinical Professor, University of California, Sun Francisco

V O L U i M E IS, i S U . M R E R I . 2 0 0 3

31