Endodontology, Vol.

16, 2004

Current Endodontic Literature

Fracture resistance of endodontically treated teeth restored with
composite posts
Marcela P. Newman, DDS, MS, Peter Yaman, DDS, MS, Joseph Dennison, DDS, MS, Mary
Rafter, DDS, MS, and Edward Billy, DMD, MS
School of Dentistry, University of Michigan, Ann Arbor, Mich.
Statement of problem : The most recent application of fiber-reinforced composites involves
their use as post and core systems to restore endodontically treated teeth. Even though this last
application has been advertised and used clinically by many dentists, there is very little information
regarding the physical properties of these post systems.
Purpose : The purpose of this study was to compare the effect of 3 fiber-reinforced composite
post systems on the fracture resistance and mode of failure of endodontically treated teeth.
Material and methods : Ninety maxillary central incisors were divided into 8 experimental groups
and 1 stainless steel (Para Post) control group of 10 specimens each. Eighty teeth were assigned
to 2 main experimental groups called narrow and flared canals. For the narrow canal group,
post spaces were prepared with the corresponding reamer to restore he teeth with Fibre Kor,
Luscent anchors, and Ribbond posts of 1.5 mm. And 2.0 mm in diameter, respectively. For the
flared canals group thin-walled canal were simulated. Teeth for the flared canals were restored
with the same posts but were cemented into rapered 2 mm wide canals created with a tapered
diamond bur. Prefabricated posts (Fibre Kor and Luscent anchors) for narrow and flared canals
were cemented with an autopolymerzed resin cement and a flowable composite, respectively,
whereas customized Ribbond posts were luted with a light-polymerized flowable composite for
both canal types. An additional set of 20 Ribbond posts with coronal portions of variable size and
shape referred to as Ribbond non standardized were also prepared and evaluated Specimens
were loaded to failure (kg) with a universal testing machine at a crosshead speed of 0.05 cm/min
until failure occurred. Data were analyzed with analysis of variance and Student t tests (p<.05).
Results : Statistical analysis revealed no significant difference between flared and narrow canals
in mean load to failure between the post systems except for the Ribbond posts (p<.01). For the
narrow canal, the mean load ranged from a low of 4.55 + 1.49) kg for the Ribbond standard to a
high of 12.9 (+ 1.64) kg for the Luscent anchors. For the flared canal the low mean was 9.04
(+1.76) kg for Fibre Kor and the high was equal for both Luscent anchors and Ribbond standard,
12.87 (+2.69) and 12.87 (+3.54), respectively. Ovrall, the ParaPosr control group had the highest
load value (18.33 + 3.27 kg) p<.05). Ribbond nonstandardized had a mean load to failure of
24.+91 (+11.53) Kg for the narrow canal group and 31.95 (+11.98) kg for the flared canal. Results
from these groups were excluded from the statistical analysis because of the uncontrolled core
sizes and high standard deviations. No root fractures occurred in any of the experimental groups.
Conclusion : Results from the study show that the load to failure of the stainless steel posts
were significantly stronger than all the composite posts studies. However, the mode of failure or
deflection of the fiber-reinforced composite posts is protective to the remaining tooth structure.
Source : J. Prosthet Dent 2003;89:360-7.
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 Current endodontic literature

Fracture resistance of prepared teeth restored with bonded inlay

restorations
Annie J. St-Georges, DMD, MS, John R. Sturdevant, DDS, Edward J. Swift Jr. DMD, MS, and
Jeffrey Y. Thompson, PhD.
Faculty of Dental Medicine, University of Montreal, Montreal, Canada; School of Dentistry,
University of North Carolina, Chapel Hill, N.C.
Statement of problem : Tooth preparation weakens the remaining tooth structure.
Purpose : This study attempted to measure and compare the strength of intact, prepared, and
resto4red human maxillary premolars.
Material and methods : Fifty intact, non carious human maxillary premolars were divided into 5
groups of 10 and wee mounted with their roots imbedded in autopolymerized acrylic. In the first
group, the teeth were intact with no preparation. In the other 4 groups, Class II MOD preparations
were made with a water-cooled high-speed hand piece. In 1 group, the cavity preparations were
restored with bonded CAD/CAM ceramicinlays. In 2 groups, the preparations were restored with
bonded CAD/CAM composite inlays (acid etched or air particle abraded). In the final group, the
teeth were prepared but unrestored. Specimens were tested individually in a universal resting
machine, in which a 4.82 mm diameter steel sphere plunger was mounted in the crushed moving
at 0.5 mm/min. The plunger contacted the facial and lingual triangular ridges beyond the margins
of the restorations. Peak load to fracture (N) was measured for each specimen. Means were
calculated and analyzed with analysis of variance (p<.05).
Results : MOD preparations weakened the teeth by approximately 59%\. Restoring the teeth
with ceramic or composite inalys did not significantly strengthen the teeth under this testing
system. Of the restored teeth, those restored with indirect composite inlays cemented following
manufacturers recommendations had the highest fracture resistance.
Conclusion : Within the limitations of this study, under static compression load testing, bonded
inlay restorations did not strengthen maxillary premolars with large MOD preparations.
Source : J Prosthet Dent 2003; 89:551-7

Effects of post-core design and ferrule on fracture resistance of

endodontically treated maxillary central incisors
Lu Zhi-Yue, BDS, PhD, and Zhang Yu-Xing, DDS
Beijing Hospital, Beijing, Peoples Republic of China
Statement of problem : Studies concerning the effects of post-core design and ferrule on the
racture resistance of endodontically treated teeth remain controversial.
Purpose : The purpose of this study was to investigate in vitro the effects of post-core design and
ferrule on the fracture resistance of root canal treated human maxillary central incisors restored
with metal ceramic crowns.
Material and methods : Forty-eight extracted human maxillary central incisors were
endodontically treated and divided into 4 groups of 12. The following treatments were evaluated:
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 Endodontology, Vol. 16, 2004

group A: restored with metal ceramic (porcelain fused to metal [PEM]) crown as control; group B;
2 mm ferrule/custom cast post-core / PFM crowns; group C: no ferrule/custom cast post-core /
PFM crowns; and group D: 2-mm ferrule / prefabricated post and resin core/PFM crowns. Each
specimen was subjected to load (N) on the lingual surface at a 135-degree cm/min. One way
analysis of variance and nonparametric chi-square test were used to compare the results. A
significant analysis of variance result was followed by Newman Keuls pairwise multiple
comparisons (p<.05).
Result : There were significant differences among the 4 groups studies (p<.01). Group B had the
highest fracture strength (1793.59 + 387.93N). There was no significant difference among the
fracture resistances of the other 3 groups (group A: 958.49 + 286.02 N; group C: 992.98 + 291.00
N; group D: 994.94 + 285.04 N).
Conclusion : Within the limitations of this study, not all of the post-core structures tested improved
the strength of the endodontically treated teeth. Those prepared with a 2-mm dentin ferrule more
effectively enhanced the fracture strength of custom cast post-core restored endodontically treated
maxillary central incisors.
Source : J Prosthet Dent 2003; 89:368-73.

The Influence of filling technique on depth of tubule penetration by root

canal sealer: A study using light microscopy and digital image processing
By Gustavo A. De Deus, DDS, MS; Eduardo Diogo Gurgel-Filho, DDS, MS, PhD; Claudio Maniglia-
Ferreira, DDS, MS, PhD; Tauby Coutinho-Filho, DDS, MS, PhD.
Department of Endodontics, Rio de Juneiro State University - UERJ, Brazil. Department of
Endodontics, University of Fortaleza, UNIFOR, Fortaleza, Brazil

Abstract : The purpose of this study was to compare the depth of sealer penetration into dentinal
tubules by three root-filling techniques using light microscopy and digital image processing.
Thirty-two maxillary central incisors were prepared. Two teeth were separated for the control
group. The rest were divided into three equal groups and-Obturated as following - G I : lateral
condensation; G2:warm vertical compaction of gutta-percha and G3: T) 1ermafil system. Each
sample was sectioned longitudinally and prepared for microscopic analysis. A sequence of
photomicrographs with magnifications of XSO, X200 and XSOO were taken. Through digital image
analysis and processing, measurements for each field were obtained. A non-parametric ANOVA
Kruskal-Wallis analysis was used to determine whether there were significant differences among
the groups. Significant differences between G2 and G I (p = 0.034) and between G3 and G I (p =
0.021) were identified. There were no significant differences between G2 and G3 (p > 0.05). The
results of this research suggest that samples root-filled by thermoplasticised gutta-percha
techniques lead to deeper penetration of the root canal sealer into the dentinal tubules.
Source : Austr. Endod. J. 2004; 30:23-28

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 Current endodontic literature

Carious pulpitis: Microbiological and histopathological considerations

Dr E Elizabeth Martin, BDS (Hons), MOS, PhD, FRACOS, Faculty of Dentistry, University of
Sydney, Australia.
Address for correspondence: Dr E Elizabeth Martin, Faculty of Dentistry, University of Sydney,
Westmead Centre for Oral Health, Westmead Hospital, PO Box 533, Wentworthville, NSW,
2145, Australia.

Abstract : Dental caries is the result of microbial activities that induce the progressive localized
destruction of teeth. Without treatment, this eventually results in infection of the dental pulp and
surrounding periapical tissues. Although the bacteria responsible for caries initiation and early
caries progression have been extensively studied, the microbiology of dentine caries reportedly
shows considerable diversity and the associated microflora has not yet been fully identified. A
search of the literature shows that few studies have analyzed the microbiology of deep caries or
examined the relationship between this microflora and the histopathology of chronic pulpitis in
symptomatic teeth.
The majority of the studies investigating the microbiology of carious dentine have used traditional
culture methodology that has been reported to be fraught with difficulties and to underestimate
the microbial populations. However, recent work using new technology in the form of Polymerase
Chain Reaction (PCR) has shown potential by enhancing the identification and quantification of
bacteria from complex environments. Application of this technology to carious dentine has identified
an environment dominated by anaerobic organisms and containing significant numbers of Gram-
negative bacteria that have been strongly implicated in endodontic infections subsequent to carious
pulpitis.
Examination of the histopathology of pulp sections from teeth extracted as a result of carious
pulpitis showed pulpal reactions ranging from minimal inflammation to marked inflammatory
infiltration of the pulp tissue. Of interest, were hard and soft tissue pathologic changes noted in
the pulp tissues resulting from the combined effects of the carious microorganisms and the host
tissue response.
Improved knowledge of the microbial species associated with pulpitis could create the potential
for development of diagnostic tools and restorative materials with appropriate antimicrobial
properties.

Source : Austr. Endod. J. 2004; 30:23-28

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