Biomechanical considerations for the restoration of endodontically treated teeth: A systematic review of the literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies)

Department of Cariology and Endodontics, School of Dentistry, University of Geneva, Geneva, Switzerland.
Quintessence international (Berlin, Germany: 1985) (Impact Factor: 0.73). 03/2008; 39(2):117-29.
Source: PubMed

ABSTRACT OBJECTIVE: The restoration of endodontically treated teeth has long been guided by empirical rather than biomechanical concepts. Part I of this literature review presented up-to-date knowledge about changes in tissue structure and properties following endodontic therapy, as well as the behavior of restored teeth in monotonic mechanical tests or finite element analysis. The aim of the second part is to review current knowledge about the various interfaces of restored, nonvital teeth and their behavior in fatigue and clinical studies. REVIEW METHOD: The basic search process included a systematic review of articles contained in the PubMed/Medline database, dating between 1990 and 2005, using single or combined key words to obtain the most comprehensive list of references; a perusal of the references of the references completed the review. RELEVANT INFORMATION AND CONCLUSIONS: Nonvital teeth restored with composite resin or composite resin combined with fiber posts resisted fatigue tests and currently represent the best treatment option. In comparison to rigid metal and/or ceramic posts, when composite resin or composite resin/fiber posts fail, the occurrence of interfacial defects or severe tooth breakdown is less likely. Adhesion into the root, however, remains a challenge because of the unfavorable ovoid canal configuration, as well as critical dentin microstructure in the deepest parts of the canal. Thus, specific combinations of adhesives and cements are recommended. The clinical performance of post-and-core restorations proved satisfactory overall, in particular with a contemporary restorative approach using composite resin and fiber posts. However, the clinical literature does not clearly isolate or identify exact parameters critical to success. This, in turn, emphasizes the importance and relevance of in vitro studies to further improve the quality and long-term stability of prosthetic foundations.

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    • "From a mechanical point of view, a post/core/crown restored tooth can be considered a structure formed by multiple components with a complex geometry [20]. Clinically, the failure of these restorative systems will occur in the form of root fracture or post dislodgement [21] [22] [23]. "
    10th World Congress on Computational Mechanics; 05/2014
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    • "Oval canals are prevalent in the human dentition, and bonding procedures are difficult to perform in such canals (Schwartz & Robbins 2004, Tay et al. 2005, Cleghorn et al. 2007, Dietschi et al. 2008). Circular posts are commonly employed, and resin cement is used to compensate for their lack of adaptation to the canal walls. "
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    ABSTRACT: To evaluate ex vivo the bond strength and adaptation of fibre posts with oval and circular cross sections luted in oval canals with post spaces prepared using dedicated drills or ultrasonic tips. Forty extracted premolars with oval canals were root filled, then randomly divided into four groups according to the post space preparation device and the shape of the luted fibre post: dedicated drill + round post, dedicated drill + oval post, ultrasonic tip + round post and ultrasonic tip + oval post. Posts were cemented with a self-adhesive cement (RelyX Unicem 2; 3M ESPE). Samples were sectioned in 1-mm-thick slices and observed under a microscope, and the area occupied by the post within the post space area was calculated. Bond strength was then measured using a push-out test, and the failure modes were evaluated with a stereomicroscope at 40× magnification. Fibre post adaptation and push-out test results were evaluated by analysis of variance (P < 0.05). Fibre posts, both round and oval, were better adapted to the apical region of the post space (P = 0.001). In oval canals, the bond strength was significantly higher in coronal regions, when the post space was prepared with a dedicated drill and an oval post was luted (P < 0.0001). Adhesive failures between cement and post were the most frequent type of failure in all groups. Circular and oval posts achieved similar adaptation to oval canals, but the use of ultrasonic tips and round posts resulted in reduced bond strength values.
    International Endodontic Journal 07/2013; 47(4). DOI:10.1111/iej.12156 · 2.27 Impact Factor
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    • "The preferred final restoration for endodontically treated posterior teeth remains contentious. The conventional means of restoring endodontically treated teeth is a build-up with a post and core, which utilizes adhesive procedures and placement of a full coverage crown with sufficient ferrule [9] [10] [11]. However, preparing a post space also involves a certain degree of risk of accidental root perforation. "
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    ABSTRACT: This study evaluated the risk of failure for an endodontically treated premolar with MOD preparation and three CEREC ceramic restoration configurations. Simulations were performed based on three 3D finite element (FE) models designed with CEREC ceramic inlay, endocrown and conventional crown restorations. Long-term failure probability in relation to varying load conditions was calculated by incorporating the Weibull function in FE analysis. Additionally, the final fracture strength and corresponding load value of the first acoustic emission (AE) activity in each specimen was recorded by performing in vitro AE analysis in CEREC restored teeth compressive testing. Simulation results indicated that the stress values on the enamel, dentin and luting cement for endocrown restorations were the lowest ones among the corresponding values for inlay and conventional crown restorations. Weibull analysis indicated that failure probability was 95%, 2% and 2% for the inlay, endocrown and conventional crown restorations, respectively, for normal biting. AE analysis revealed that, although the significantly least load was required for the first AE activity for inlay configuration, the endocrown and conventional crowns did not significantly differ from each other. This in vitro study, i.e. numerical and AE analyses, suggest that endocrown and conventional crown restorations for endodontically treated premolars with MOD preparation present a similar longevity.
    Dental materials: official publication of the Academy of Dental Materials 05/2011; 27(5):431-8. DOI:10.1016/ · 4.16 Impact Factor
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