Abstract
BackgroundEndodontically treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture. An apical plug is usually used as root end filling in order to seal the wide apical foramen. The current study was performed to evaluate the effect of different apical plug materials (MTA and Calcium enriched mixture cement) at varied thicknesses on fracture resistance of teeth restored with cast metal posts.MethodsA total of 40 extracted intact single-rooted human mandibular premolars (removed for orthodontic reasons) were used in the study. The coronal part of each tooth was removed and root canal preparation was performed. A size 4 Gates Glidden drill was used to enlarge the canal and was passed through the apical foramen in order to simulate an immature apex. Samples were randomly divided into 5 groups (n = 8) according to apical plug (control group: No plug, group MTA5: 5 mm MTA plug, group CEM5: 5 mm CEM plug, group MTA3: 3 mm MTA plug, group CEM3: 3 mm CEM plug). Post-space preparations were performed and cast metal post-and-cores were fabricated and cemented. Fracture resistance was assessed using a universal testing machine. Fracture thresholds were recorded and data were analyzed using One-way ANOVA and Dunnett’s T3 tests with significance level at P value < 0.05.ResultsThe analysis showed a significant difference of fracture resistance between groups (P value < 0.05). The mean fracture resistance of samples in control group was significantly lower than MTA5 (P value = 0.003). There was no significant difference between other groups (P value > 0.05).ConclusionsWithin the limits of this study, the evidence indicated that placement of a 5 mm MTA apical plug increased the fracture resistance in simulated immature teeth which are restored with cast metal posts, compared to control group (gutta-percha and sealer). While the results were not as promising for a 3 mm MTA apical plug or either 3 or 5 mm CEM apical plug.
Highlights
Treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture
Different materials have been advocated as apical plug materials, among which bioceramic-based materials such as Mineral trioxide aggregate (MTA), BioAggregate, Biodentine, Calcium enriched mixture cement (CEM) are of the most popular materials [7]
The current study was performed to evaluate the effect of different apical plug materials (MTA and CEM) at varied thicknesses on fracture resistance of teeth restored with cast metal posts and to the best of our knowledge, this is the first study to do so
Summary
Treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture. The current study was performed to evaluate the effect of different apical plug materials (MTA and Calcium enriched mixture cement) at varied thicknesses on fracture resistance of teeth restored with cast metal posts. Achieving an appropriate apical seal which is essential for prevention of microorganism’s ingress, is challenging in immature teeth, due to the wide apical foramen [5, 6]. The use of bioceramicbased materials has shown to decrease the fracture susceptibility compared to calcium hydroxide paste which was traditionally used for endodontic treatment of immature teeth before introduction of bioceramic-based materials [4, 8, 9]
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