Fracture resistance of endodontically treated teeth restored with composite posts

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.

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.

Ninety maxillary central incisors were divided into 8 experimental groups and 1 stainless steel (ParaPost) 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 the teeth with FibreKor, Luscent anchors, and Ribbond posts of 1.5 mm, 1.6 mm, and 2.0 mm in diameter, respectively. For the flared canals group thin-walled canals were simulated. Teeth for the flared canals were restored with the same posts but were cemented into tapered 2 mm wide canals created with a tapered diamond bur. Prefabricated posts (FibreKor and Luscent anchors) for narrow and flared canals were cemented with an autopolymerized 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 nonstandardized" 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).

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 FibreKor and the high was equal for both Luscent anchors and Ribbond standard, 12.87 (+/-2.69) and 12.87 (+/-3.54), respectively. Overall, the ParaPost 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.

Results from the study show that the load to failure of the stainless steel posts were significantly stronger than all the composite posts studied. However, the mode of failure or deflection of the fiber-reinforced composite posts is protective to the remaining tooth structure.