Available online at www.jbr-pub.org.

cn
Open Access at PubMed Central

The Journal of Biomedical Research, 2019 33(2): 131–138

Original Article

Effect of restoration technique on resistance to fracture of

endodontically treated anterior teeth with flared root canals
Sary S Borzangy1, Samah M Saker2, ✉, Walid A Al-Zordk2
1
Department of Substitutive Dental Sciences, College of Dentistry, Taibah University, Medina 42353, Saudi Arabia;
2
Department of Fixed Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt.

Abstract
This study was designed to compare the impact of post and core systems on resistance to fracture of endodontically
treated anterior teeth with flared root canals and to assess their fracture pattern. Sixty central incisors were cut
horizontally 2 mm coronal to the cementoenamel junction (CEJ). After root canal therapy, teeth were assigned into 6
groups (n = 10 each) based on a post system and used as follows: Group C, non-flared root received size #1 glass fiber
posts (Control); Group AP, flared root restored with anatomical post; Group RC, flared root restored with size #1 fiber
post and cemented with thick layer of resin cement; Group CR, flared root restored with size #1 and reinforced with
composite resin; Group CM, cast post-core; Group CP, CAD/CAM polymer-infiltrated ceramic post and core.
Following post cementation, core build-up and crown insertion, the specimens were thermo-cycled up to 10,000
cycles (5C/55C; 30 seconds dwell time, 6 seconds transition time) and then statically loaded at 1 mm/minute
crosshead speed using a universal testing machine. One-way ANOVA and Tukey HSD post hoc test (α = 0.05) were
used for data analysis. Group C recorded significantly higher resistance to fracture values [(826.939.1) N] followed
by group CP [(793.855.6) N] while group RC yielded the lowest fracture resistance values [(586.751.4) N]. The
resistance to fracture of wide root canals can be enhanced by using one-piece CAM/CAM post and core as an
alternative to the use of either glass fiber post, relined with composite resin increasing the thickness of luting cement
or the use of cast post and core system. However, this was an in vitro investigation and further in vivo studies are
necessary.
Keywords: anatomical post, customized post, endodontically treated teeth, flared root canal

Introduction and a post is essential to hold an artificial core that will

restore the tooth loss[1–5]. For many years, many dental
Long-term clinical performance of root-canal treated practitioners believed that a post would “reinforce” the
teeth depend primarily on the amount of the tooth’s tooth structure[6–7], however, the volume of dentin
remaining structure. Teeth with extensive tooth loss remaining is of most relevance to tooth strength[8–11].
have reduced capacity to resist forces during function During post space preparation procedure, it is recom-

✉
Corresponding author: Dr. Samah Saker, Box 35516, Al-Gomhoria The authors reported no conflict of interests.
St, Faculty of Dentistry, Mansoura University, Mansoura 35516, This is an open access article under the Creative Commons
Egypt. E-mail: samah_saker@hotmail.com. Attribution (CC BY 4.0) license, which permits others to distribute,
Received 17 September 2017, Revised 22 January 2018, Accepted remix, adapt and build upon this work, for commercial use, provided
23 February 2018, Epub 26 March 2018 the original work is properly cited.
CLC number: R783.1, Document code: A
© 2018 by the Journal of Biomedical Research. https://doi.org/10.7555/JBR.32.20170099
132 Borzangy SS et al. J Biomed Res, 2019, 33(2)

mended that the remaining dentin should be preserved Materials and methods
as much as possible. Resistance to fracture of root canal-
filled teeth depends primarily on the remaining root Specimens preparation
dentin thickness, especially in the bucco-lingual direc- Sixty extracted intact human maxillary central
tion[12]. The cervical portion of the root canal may be incisors of similar-sized, devoid of caries or cracks,
left widely prepared and surrounded only by a thin with straight root canal were used in this study. The
dentinal wall. And as a result of over-preparation of root teeth were debrided, cleaned with ultrasonic scaler and
canal, removal of extensive caries, and recurrent caries brush and residual tissue tags were scraped from the
around the post into the root canal dentin thus, reduce roots. After cleaning, the teeth were stored in a 0.1%
the fracture resistance[2,9,13–14]. Vertical root fracture of thymol solution at 4 °C up to 3 months following
endodontically treated teeth, with wide root canals, extraction before use. Coronal portions of the teeth were
represents a critical clinical dilemma[15], although the transversely cut 2 mm incisal to the cementoenamel
use of fiber posts (FP) has improved the long-term junction (CEJ) with a low-speed, water-cooled diamond
clinical success[8]. disk followed by flattening of the sectioned surfaces
Many studies have been conducted in order to with silicon carbide paper (600 grit).
develop a reliable technique of reinforcing endodonti-
cally treated teeth with wide root canals[16–19]. Grandini Root canal obturation
et al.[20] described a technique for reconstruction of After pulpal tissue removal, a step-back technique
compromised endodontically treated tooth by using an was used for root canal preparation using final file size
“anatomical post”, where a composite resin was used number 50 (Dentsply Maillefer, Ballaigues, Switzer-
for FP relining so the shape of the post-core matched land) at the working length that was set at 1 mm away
those of a flared post space. This technique is from the apical foramen. A 5.25% NaOCI irrigant was
undoubtedly effective to minimize the volume of luting used after each file and up to the final size, followed by
cement, and reduce its polymerization shrinkage[21–29]. rinsing with distilled water. The prepared root canals
In addition, various materials have been recom- were obturated with gutta-percha cones (Dentsply
mended in order to fill flared root canal with a Maillefer, Ballaigues, Switzerland) after completely
biocompatible material with similar physical properties drying with paper points using a lateral condensation
to those of dentin to increase the resistance fracture of technique and AH-Plus sealer (Dentsply IH Ltd, United
weakened roots like composite resins and glass ionomer Kingdom). After obturation, the coronal opening of the
cements[19,27,29]. The post system chosen to retain a root canal was closed with a temporary restorative
restoration must present biomechanical properties material (Cavit-G, 3M ESPE, Minnesota, United States)
similar to dentin and provide adequate retention and and the teeth were stored for 7 days at 37 °C and at
stiffness to prevent any micro-movement between an 100% humidity.
artificial crown and a root face. Glass fiber post systems
were introduced with advantages in respect to their Study groups
biomechanical properties and to transmit light similar to To simulate the periodontal ligaments effect, a thin
that of tooth structure[6–9]. coat of polyvinylsiloxane impression material was
Recently, Chen et al.[30], studied a novel technique to painted on the root surface. With the aid of a
fabricate a custom glass fiber post-and-core with CAD/ centralization device, the specimens were embedded
CAM system for restoration of compromised endodon- vertically in an epoxy resin (Kemapoxy, CMB chemi-
tically treated root canal in vivo and they reported the cals, Giza, Egypt) at a depth of 2 mm apical the CEJ. To
effectiveness of this technique to be used for restoration standardize the post space preparation, the endodonti-
of flared root canal-treated teeth. cally treated canal were initially prepared to receive a
Therefore, this investigation was conducted to size #1 post (RelyXTM, 3M ESPE, St. Paul, Minnesota,
evaluate fracture resistance of anterior teeth with flared United State) of 1.3 mm diameter using matching
root canals restored with glass fiber posts, cast post and stainless steel low-speed reamers and the depth was
core and CAD/CAM post and core fabricated from limited to 10 mm using a rubber stopper as a reference
VITA Enamic. The null hypothesis tested was there (Fig. 1). The preparation drill was changed after five
would be no significant difference in fracture resistance preparations so each group used two drills. The
between the four different materials used. Fracture specimens were assigned into 6 groups (n = 10).
pattern were also evaluated for each test group. Group C: control, non-flared roots; groups AP, RC, CR,
 Fracture resistance of endodontically treated teeth with flared root canal 133

Fig. 1 Schematic diagram showing the steps of root canal obturation, gutta-percha removal and flaring of the post space.

CM and CP: flared roots in which the roots were further followed by solvent evaporation and finally light cured
prepared to simulate roots with flared post space using for 10 seconds. The fiber posts were covered with
2.5 mm diamond burs (#413, KG Sorensen, São Paulo, composite resin (Tetric N-Ceram, Ivoclar Vivadent)
SP, Brazil) in a low speed hand piece limited to 10 mm then inserted into the canal that previously lubricated
vertical length to achieve approximately 1 mm wide with a water-soluble gel (KY, Johnson & Johnson). A
coronal root dentinal wall (Fig. 1). customized centralization device was used to aid in
guiding and positioning of the lined post in the center of
Restoration of the prepared post space the prepared post space with an even thickness of the
Before post insertion, the posts were airborne-particle composite resin around the post. To insure accurate
abraded with 50-µm alumina particles (Heraeus Kulzer) fitness, the relined fiber post was removed and replaced
using a custom-made revolving wheel at 250 kPa twice. After removal of the excess resin composite
pressure for 5 seconds. material, the relined fiber post was light cured for 20 sec
Group C (Control, n = 10): the specimens of this with the post inside the post space followed by
group were restored with size #1 fiber posts (RelyXTM, additionally curing for 20 seconds from the buccal,
3M ESPE, St. Paul, Minnesota, United State). lingual, mesial, and distal surfaces outside the post
Group AP (n = 10): flared post spaces were restored space. The root canals and the relined fiber posts were
using size #1 fiber posts, relined with composite resin. then rinsed abundantly with water to remove the
The fiber post was coated with a layer of silane coupling lubricant gel (Fig. 2).
agent (Prosil, FGM) for 1 minute, and it was gently air Group RC (n = 10): flared post spaces were restored
dried for 5 seconds and coated with two-step etch-and- using size #1 fiber posts cemented with self-adhesive
rinse bonding agent (Tetric N-Bond, Ivoclar Vivadent), dual-polymerizing resin luting material RelyX Unicem

Fig. 2 Schematic illustration of the flared roots restored with: anatomical post (AP); size #1 fiber post cemented with thick layer of
resin cement (RC); size #1 fiber post reinforced with composite resin (CR); cast post and core (CM); CAD/CAM polymer-infiltrated
ceramic post and core.
134 Borzangy SS et al. J Biomed Res, 2019, 33(2)

re-prepared with size #0 drill corresponding to the #0.5

post.
Group CM: the canals were lubricated and the
autopolymerizing resin (DuraLay II, Reliance Dental
Mfg Co) was added over the plastic dowel using bead-
brush technique. The pattern was removed inspected
after 3 minutes according to instructions of the
manufacturer. After refitting the post, the core portion
was formed by addition of more pattern resin. The final
shaping of the core was done with finishing burs. The
patterns were invested and casted with Ni-Cr alloy
(Kera NH; Eisenbacher Dentalwaren).
Group CP: the patterns of posts and cores were
fabricated as described in group CM. The patterns were
sprayed with anti-reflection scan powder spray (Digis-
can-Spray, Yeti). Each post-core was mounted over the
scanning tray of the extraoral scanner (Ceramill
map400, Amann Girrbach). The scanning process was
Fig. 3 Schematic illustration of the fracture resistance test
showing the load applied at 135-degree from the long axis of the performed automatically by moving the shifting plate
root and 3 mm away from the incisal edge. with the pattern fixed on it and gaining multiple camera
screening. The construction data to design the restora-
(3M ESPE, Seefled, Germany). The cement capsule was tions was performed through standard transformation
activated and mixed for 15 seconds according to language (STL) data format. The job definition on the
manufacturer’s instructions. The mixed cement was CAD/CAM software (Ceramill Mind software, Amann
injected into the prepared post space through the Girrbach) was started by selection of inlay/onlay as
elongation tip of the capsule to ensure void-free restoration type. After the software calculated the
cementation of the posts (Fig. 2). The centralization proposed design of post and core, some modifications
device was used for positioning of the post within the were made manually. The STL file was sent to the
center of the post space. After removal of excess milling unit (Ceramill Motion 2 5X, Amann Girrbach)
cement, final light-polymerization was done for 20 to mill the post and core from VITA Enamic block.
seconds on each surface as mentioned previously. After finishing, the post surfaces were conditioned for
Group CR: reinforcement of flared root canal with 60 seconds with hydrofluoric acid (IPS Ceramic Etching
composite resin. The dentin walls of the post space were gel, Ivoclar Vivadent) and subsequent silainization
etched for 15 seconds with 37% phosphoric acid gel (vitigue silane primer, DMG Hamburg, Germany) was
(Total Etch, Ivoclar Vivadent; Schaan, Liechtenstein) done (Fig. 2).
then rinsed and dried with paper points. The two-step Self-adhesive resin cement was used for posts
etch-and-rinse bonding material was applied on the cementation following the instructions of the manufac-
entire canal surface in two coats with the aid of a turer. The composite resin cores (Filtek Z250; 3M
microbrush, as recommended by the manufacturer. ESPE) were fabricated in a standard manner for all
After solvent evaporation, the adhesive was light groups except groups CM and CP using core-forming
cured for 10 seconds by positioning the tip of the matrices (Ultra-form; Ultradent Products Inc). All
light-curing unit at the entrance of the root canal. A specimens were prepared to receive complete cast
flowable composite resin (Tetric N-Flow, Ivoclar crowns preparation with 0.5 mm width using a diamond
Vivadent) was used to fill in the post space from the bur at high speed with water spray.
apex to the cervical portion to avoid the formation of air
Crown fabrication and cementation
voids. After this, the glass-fiber post #1 was lubricated
with the water-soluble gel (KY, Johnson & Johnson) Wax pattern of each crown was made directly on the
and inserted into the canal by using a centralization specimen with a polyvinyl siloxane putty index (Lab
device. The flowable composite resin was light cured Putty; Coltène/Whaledent), to simulate the anatomy of
for 20 seconds after the removal of the fiber post, the central incisor with an 11 mm length, and a lingual
root canals were rinsed abundantly with water to notch 3 mm apical to the incisal edge. To standardize the
remove the lubricant gel. The fiber posts were rinsed dimensions, each wax pattern was measured with a wax
and cleaned. Afterwards, the post spaces were slightly caliper. The wax patterns were invested and cast in Ni-
 Fracture resistance of endodontically treated teeth with flared root canal 135

Table 1 Mean and standard deviations of fracture resistance values (N) of experimental groups
Groups N Mean
Control 10 826.939.1a
Anatomical post 10 686.252.5b
Resin cement 10 607.754.8c
Composite resin 10 727.464.3b
Cast post and core 10 771.77.3d
CAD/CAM post and core 10 793.855.6 a

Significant difference (P≤0.05) was found among groups marked by different letters (a, b, c) while no significant difference was found among groups marked
by similar letters.

Cr alloy following the manufacturer’s instructions. The horizontal fracture and oblique fracture below the
inner surfaces cast crowns were airborne-particle cervical third of root that would necessitate extraction
abraded at 0.25 MPa pressure with 150 mm alumina of the remaining tooth structure).
particles (Al2O3; Heraeus Kulzer) and ultrasonically
cleaned in 96% isopropanol. The prepared tooth Statistical analysis
surfaces were cleaned with pumice, rinsed, and dried The homogeneity of data were evaluated using
before final cementation with resin cement following Kolmogorov-Smirnov and Levene normality tests.
the manufacturer’s recommendations. The specimens Statistical analysis was performed with software
were thermocycled up to 10,000 cycles (5C/55C; 30 (SPSS 20.0, SPSS Inc, Chicago, IL). Fracture resistance
seconds dwell time, 6 seconds transition time). data (N) were analyzed by one-way analysis of variance
(ANOVA) followed by the Tukey HSD post hoc test (α
Fracture strength test
= 0.05) multiple comparisons.
A standard testing machine (Lloyd Instrument, LTD,
West Fareham, UK) was used at a crosshead speed of
Results
1.0 mm/minute with a 5 kN load cell to apply a
unidirectional static load at an angle of 135 degrees Means and standard deviations of resistance to
from the long axis of the root (Fig. 3), applied to a fracture values recorded for the test groups were listed
groove located at the palatal concavity of the crown in (Table 1). Kolmogorov-Smirnov and Levene normal-
located 3.0 mm away from the incisal edge of the ity tests revealed normal and relative (marginal)
restoration. The load was applied until fracture. The distributions of data. Therefore, a parametric ANOVA
force at which initial root fracture occurred was analysis test was conducted to evaluate the difference of
recorded in Newtons (N). Specimens were visually fracture resistance values among groups (Table 2).
inspected to determine the location, type, and direction The highest overall fracture resistance (N) was
of failure. The failure mode was recorded and classified observed in control group (82739.1), followed by
as either “repairable or favorable” (detachment of the
post and core and/or fracture of cervical third of the root
that could be repaired through fabrication of a new
restoration) or “irreparable or catastrophic” (vertical or

Table 2 Percentage of failure modes observed within each

experimental group
Percentage of failure modes (%)
Group
Favorable Non-favorable
Control 80 20
Relined post 60 40
Composite resin 70 30
Resin cement 40 60
Cast post and core 30 70
Fig. 4 Photograph representing an example of a favorable type
CAD/ CAM post and core 70 30 of failure with detachment of the post and core system that could
be repaired.
136 Borzangy SS et al. J Biomed Res, 2019, 33(2)

hypothesis. There was a significant difference in

resistance to fracture of endodontically treated teeth
with non-flared root canals compared to teeth with
flared root canals restored with fiber post, cast post and
core and CAM/CAM post and core.
The higher resistance to fracture values recorded for
the control group can be explained by the greater
amount of remaining dentin. Dentin exhibits consider-
able plastic deformation that enables resistance of
different angles and degrees of load applied during
normal occlusal function. Tooth fracture occurs when
the applied loads exceeded the tensile strength or
proportional limit of dentin as capability of dentin for
plastic deformation is decreased. This result is
supported by the finding of Zogheib et al.[17], who
Fig. 5 Photograph representing an example of a non-favorable stated that the fracture resistance of endodontically
type of failure with an oblique fracture below the cervical third of treated teeth is directly proportional to the amount of
root that would necessitate extraction of the remaining tooth remaining root canal dentin.
structure.
The CP group showed higher resistance to fracture
values compared to CR, AP and RC groups. This
CP group [793.855.6) N] while the RC group showed
finding could be related to the modulus of elasticity of
the least fracture resistance values [(607.754.8) N].
VITA Enamic which is comparable to those of the hard
The CR reinforced group showed comparable fracture
tooth structure[31–33]. Additionally, the difference in
resistance values to the AP group where the mean
chemistry between the composite core material and the
values [(727.464.4) N] and [(686.252.5) N] respec-
epoxy resin of the fiber post matrix, a weak link is
tively, while the CP showed comparable fracture
formed which is partially responsible for the high failure
resistance to CM group [(77171.3) N]. The results
rate happened in preformed fiber post and core systems.
revealed a significant difference (P < 0.05) in fracture
In order to overcome the failure at interfaces, the post
resistance values of the CP group compared to the CR,
and the core should be fabricated as one piece.
AP and RC groups. No significant differences were
The finding of this study showed that the root
found among fracture resistance values of the AP group
resistance to fracture of the CR group was significantly
compared to CR groups. Additional analysis with the
higher than the RC group. This finding was supported
Tukey test showed significant differences (P < 0.001)
by a study conducted by Amin et al.[21] who reported
among study groups as well. Predominately restorable
that reinforcement of the flared post space using
failure observed in the C group was 80% while the CP
composite resin improved the fracture resistance of
and CR groups recorded 70% as shown in Table 3.
the weakened roots compared to rehabilitated using
However, groups RC, AP and CM recorded a lesser
luting cement. Additionally, thick layers of resin cement
percentage of favorable failure (60%, 40% and 30%,
incorporate more bubbles, cracks, or gaps compared to
respectively (Fig. 4–5).
the thin one. These defects initiate a stress concentration
zone, which acts as crack raisers and reduces the bond
Discussion strength of the fiber post to root canal dentin[25]. Root
fracture might be induced due to the wedging effect of a
Restoration of root-canal treated teeth with wide root loose post within a root canal as a result of adhesion
canals using post and core systems still a challenging failure between root canal dentin and resin cements. The
process as the mismatch between the wide diameter of stress accumulated in the post is transferred by the
the flared root canals and standardized rounded dentin to the outer surface of the tooth. In case of a thin
diameter of prefabricated post results in thick cement dentinal wall and /or thick resin cement layer, the load
layer. Furthermore, the restoration of these flared root required to initiate tooth fracture is minimized, as
canals may be a compromised treatment as the occurred in groups RC and AP in this study.
remaining tooth structure is too weak to tolerate the Although the use of anatomical post increases the
normal masticatory forces and as a consequence the post adaptation to root canal walls and decreases the
teeth are liable to fractures[21–22]. The findings of this in thickness of resin cement[22–23,27]. Gomes et al.[24]
vitro investigation support the rejection of the null showed that the use of composite resin as a root
 Fracture resistance of endodontically treated teeth with flared root canal 137

reinforcement material improves fracture resistance of fracture resistance of glass-fiber and cast metal posts with
weekend root compared to the use of direct anatomical different lengths[J]. J Prosthet Dent, 2009, 101(3): 183–188.
post. Other studies[18,25–26] reported that, to strengthen [3] Mangold JT, Kern M. Influence of glass-fiber posts on the
root-canal treated teeth with flared root canals, a firm fracture resistance and failure pattern of endodontically treated
bond between restorative materials and the root dentin is premolars with varying substance loss: an in vitro study[J]. J
critical. However, various complicating factors could Prosthet Dent, 2011, 105(6): 387–393.
interfere with firm adhesion. Macedo et al.[22] reported [4] Silva GR, Santos-Filho PC, Simamoto-Júnior PC, et al. Effect
that the use of relined post results in increased pull-out of post type and restorative techniques on the strain and fracture
bond strengths compared with non-relined post which resistance of flared incisor roots[J]. Braz Dent J, 2011, 22(3):
could be related to the higher adaptation of the post-to- 230–237.
root canal which increases the sustained pressure during [5] Li Q, Xu B, Wang Y, et al. Effects of auxiliary fiber posts on
cementation process and consequently reduces blister endodontically treated teeth with flared canals[J]. Oper Dent,
formation in the cement that acts as a stress raiser during 2011, 36(4): 380–389.
testing. Restoration of root-canal treated teeth should be [6] McLean A. Criteria for the predictably restorable endodonti-
managed with one-piece post and core system with an cally treated tooth[J]. J Can Dent Assoc, 1998, 64(9): 652–656.
adequate fit of the post into the root canal to reduce the [7] Eckerbom M, Magnusson T. Restoring endodontically treated
liability of root fracture. teeth: a survey of current opinions among board-certified
Failure mode analysis of the test groups revealed the prosthodontists and general dental practitioners in Sweden[J].
prevalence of a favorable type of failure within C, CP Int J Prosthodont, 2001, 14(3): 245–249.
and CR groups. This could be related to the thicker [8] Valdivia AD, Raposo LH, Simamoto-Júnior PC, et al. The
dentin layer in the control group, which increases root effect of fiber post presence and restorative technique on the
fracture resistance. In the other hand, the favorable type biomechanical behavior of endodontically treated maxillary
of failure observed in the CP group could be a result of incisors: an in vitro study[J]. J Prosthet Dent, 2012, 108(3):
its modulus of elasticity that is similar to those of dentin. 147–157.
On the contrary, AP and RC groups showed the [9] Clavijo VG, Reis JM, Kabbach W, et al. Fracture strength of
prevalence of catastrophic failure. These findings are flared bovine roots restored with different intraradicular posts
in accordance with the results of other studies[22,24]. As [J]. J Appl Oral Sci, 2009, 17(6): 574–578.
the use of glass fiber posts are increasing for restoring [10] Mezzomo LA, Corso L, Marczak RJ, et al. Three-dimensional
endodontically treated teeth, further studies should be FEA of effects of two dowel-and-core approaches and effects of
conducted to assess not only the appropriate method to canal flaring on stress distribution in endodontically treated
restore flared root canal but also the appropriate post teeth[J]. J Prosthodont, 2011, 20(2): 120–129.
length that recommended in such situations. [11] Xiong Y, Huang SH, Shinno Y, et al. The use of a fiber sleeve to
The present study was an in vitro investigation that improve fracture strength of pulpless teeth with flared root
could not fully replicate the oral conditions which was canals[J]. Dent Mater, 2015, 31(12): 1427–1434.
considered a limitation of this study. Additionally, the [12] Sedgley CM, Messer HH. Are endodontically treated teeth
specimens were tested under a static loading condition, more brittle?[J]. J Endod, 1992, 18(7): 332–335.
using three types of post and core systems, and the [13] Teixeira CS, Silva-Sousa YT, Sousa-Neto MD. Bond strength
effect of ferrule was not tested. of fiber posts to weakened roots after resin restoration with
In conclusions, the resistance to fracture of wide root different light-curing times[J]. J Endod, 2009, 35(7): 1034–
canals can be enhanced by using one-piece CAM/CAM 1039.
post and core as an alternative to the use of either glass [14] Maccari PC, Cosme DC, Oshima HM, et al. Fracture strength of
fiber post relined with composite resin, increasing the endodontically treated teeth with flared root canals and restored
thickness of luting cement or the use of cast post and with different post systems[J]. J Esthet Restor Dent, 2007, 19
core system. However, this was an in vitro investigation (1): 30–36., discussion 37.
and further in vivo studies are necessary. [15] Mancebo JC, Jiménez-Castellanos E, Cañadas D. Effect of
tooth type and ferrule on the survival of pulpless teeth restored
with fiber posts: a 3-year clinical study[J]. Am J Dent, 2010, 23
References (6): 351–356.
[16] Guzy GE, Nicholls JI. In vitro comparison of intact endodonti-
[1] Hayashi M, Takahashi Y, Imazato S, et al. Fracture resistance of cally treated teeth with and without endo-post reinforcement[J].
pulpless teeth restored with post-cores and crowns[J]. Dent J Prosthet Dent, 1979, 42(1): 39–44.
Mater, 2006, 22(5): 477–485. [17] Zogheib LV, Pereira JR, do Valle AL, et al. Fracture resistance
[2] Giovani AR, Vansan LP, de Sousa Neto MD, et al. In vitro of weakened roots restored with composite resin and glass fiber
138 Borzangy SS et al. J Biomed Res, 2019, 33(2)

post[J]. Braz Dent J, 2008, 19(4): 329–333. 71–78.

[18] Faria-e-Silva AL, Pedrosa-Filho Cde F, Menezes Mde S, et al. [26] Gomes GM, Monte-Alto RV, Santos GO, et al. Use of a direct
Effect of relining on fiber post retention to root canal[J]. J Appl anatomic post in a flared root canal: a three-year follow-up[J].
Oral Sci, 2009, 17(6): 600–604. Oper Dent, 2016, 41: E23–E28.
[19] Liang BM, Chen YM, Wu X, et al. Fracture resistance of roots [27] Rahman H, Singh S, Chandra A, et al. Evaluation of fracture
with thin walls restored using an intermediate resin composite resistance of endodontically treated teeth restored with
layer placed between the dentine and a cast metal post[J]. Eur J composite resin along with fibre insertion in different positions
Prosthodont Restor Dent, 2007, 15(1): 19–22. in vitro[J]. Aust Endod J, 2016, 42(2): 60–65.
[20] Grandini S, Sapio S, Simonetti M. Use of anatomic post and [28] Farina AP, Weber AL, Severo Bde P, et al. Effect of length post
core for reconstructing an endodontically treated tooth: a case and remaining root tissue on fracture resistance of fibre posts
report[J]. J Adhes Dent, 2003, 5(3): 243–247. relined with resin composite[J]. J Oral Rehabil, 2015, 42(3):
[21] Amin RA, Mandour MH, Abd El-Ghany OS. Fracture strength 202–208.
and nanoleakage of weakened roots reconstructed using relined [29] Farina AP, Chiela H, Carlini-Junior B, et al. Influence of
glass fiber-reinforced dowels combined with a novel prefabri- cement type and relining procedure on push-out bond strength
cated core system[J]. J Prosthodont, 2014, 23(6): 484–494. of fiber posts after cyclic loading[J]. J Prosthodont, 2016, 25
[22] Macedo VC, Faria e Silva AL, Martins LR. Effect of cement (1): 54–60.
type, relining procedure, and length of cementation on pull-out [30] Chen Z, Li Y, Deng X, et al. A novel computer-aided method to
bond strength of fiber posts[J]. J Endod, 2010, 36(9): 1543– fabricate a custom one-piece glass fiber dowel-and-core based
1546. on digitized impression and crown preparation data[J]. J
[23] Conde DM, Rodrigues VP, Carvalho Souza Sde F, et al. Prosthodont, 2014, 23(4): 276–283.
Influence of Relining Post on the Bond Strength of Resin [31] Dirxen C, Blunck U, Preissner S. Clinical performance of a new
Cements[J]. J Contemp Dent Pract, 2015, 16(7): 559–564. biomimetic double network material[J]. Open Dent J, 2013, 7:
[24] Gomes GM, Gomes OM, Gomes JC, et al. Evaluation of 118–122.
different restorative techniques for filling flared root canals: [32] Albero A, Pascual A, Camps I, et al. Comparative characteriza-
fracture resistance and bond strength after mechanical fatigue tion of a novel cad-cam polymer-infiltrated-ceramic-network
[J]. J Adhes Dent, 2014, 16(3): 267–276. [J]. J Clin Exp Dent, 2015, 7(4): e495–e500.
[25] Gomes GM, Rezende EC, Gomes OM, et al. Influence of the [33] Coldea A, Swain MV, Thiel N. Mechanical properties of
resin cement thickness on bond strength and gap formation of polymer-infiltrated-ceramic-network materials[J]. Dent Mater,
fiber posts bonded to root dentin[J]. J Adhes Dent, 2014, 16(1): 2013, 29(4): 419–426.

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