Fatigue resistance of 3D printed anatomic post-and-core after mastication simulation

Rigid post-and-core systems have traditionally been used in the restoration of endodontically treated teeth and are regarded by many as the standard treatment. Flexible materials, including nanoceramic resins, are being increasingly implemented as post-and-core systems, but data supporting their use are lacking.

The purpose of this in vitro study was to compare the fatigue resistance of conventional cast metal and nanoceramic 3-dimensionally (3D) printed resin post-and-core systems with teeth without posts.

Thirty freshly extracted human maxillary premolars were endodontically treated and divided into 3 subgroups (n=10) according to the restorative procedure: cast metal post-and-core (CM), nanoceramic 3D printed resin post-and-core (3DR), and without a post (0P). The CM post-and-core group was fabricated conventionally, while the 3DR group was printed using a 3D resin printing material. For the 0P group, the teeth were restored with a composite resin foundation after root canal obturation. Complete coverage 3-mol% monolithic zirconia restorations were cemented on all specimens. The specimens were exposed to simultaneous mastication simulation (1.2 million cycles) and thermocycling (10 000 cycles at 5 ºC to 55 ºC) and analyzed based on the failure of specimens. Data were analyzed using the Kruskal-Wallis survival analysis and the Wilcoxon rank sum test (α=.05).

The Kruskal-Wallis test indicated statistically significant differences among the cycles needed to reach failure for each of the 3 groups (P<.001). At 1.2 million cycles, there were no CM failures. The 3DR group failed at a median value of 950 000 cycles, while the 0P group failed at a median value of 222 500 cycles (P<.001).

All the endodontically treated teeth that received CM survived the 1 200 000 simulated mastication cycles. Both 3DR and 0P specimens fractured at the crown cervical third during mastication simulation.