Ferrule-Effect Dominates Over Use of a Fiber Post When Restoring Endodontically Treated Incisors: An In Vitro Study.

Abstract

The aim of this study was to investigate the restoration of broken-down endodontically treated incisors with the ferrule effect using glass ceramic crowns bonded to composite resin core buildups with or without a fiber post. A no-ferrule group with post was also included for comparison. Thirty decoronated endodontically treated bovine incisors with a 2-mm ferrule were restored with a direct buildup using a nanohybrid direct composite resin (Miris 2 and Optibond FL) with or without a glass-fiber-reinforced post. An additional group of 15 teeth without a ferrule were restored with buildup and a fiber post. All teeth were prepared to receive bonded glass ceramic crowns (e.max CAD luted with Variolink Esthetic DC) and were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at an angle of 30° and a frequency of 5 Hz, beginning with a load of 100 N (×5000 cycles). A 100 N load increase was applied each 15,000 cycles. Specimens were loaded until failure or to a maximum of 1000 N (×140,000 cycles). Groups were compared using the Kaplan Meier survival analysis (log rank test at p=0.05). None of the tested specimens withstood all 140,000 load cycles. Specimens with posts but without a ferrule were affected by an initial failure phenomenon (wide gap at the lingual margin between the buildup/crown assembly and the root). There was a significant difference in mean survived cycles between the ferrule groups (Fp=73,332× and FNp=73,244×) and the no-ferrule group (50,121×; p=0.001). The addition of a fiber post was not significant in the presence of the ferrule (p=0.884). In both groups with posts, 100% of failures were unrestorable. The no-post group had 47% of restorable and possibly restorable failures. The survival of broken-down nonvital incisors was improved by the presence of the ferrule but not by the fiber-reinforced post. Fiber posts were always detrimental to the failure mode and were not able to compensate for the absence of a ferrule.