Ferrule Height Research Articles

The Effect of Varying Ferrule Modes on Fracture Resistance of Canines Restored with One-Piece Milled Zirconia Post and Core

The aim of this invitro study was to evaluate the fracture resistance of endodontically treated canines restored with one-piece milled zirconia post and core in the varying ferrule modes. Fifty recently extracted human maxillary canines were endodontically treated and randomly divided into 5 groups of 10 specimens each. According to the defect degree of ferrule, intact ferrule was classified as group A and served as control, 2 mm ferrule height without buccal ferrule was classified as group B, 2 mm ferrule height without mesial and buccal ferrule was classified as group C, 2 mm ferrule height without mesial, buccal and lingual ferrule was classified as group D, no ferrule preparation was classified as group E. All of the teeth were restored with one-piece milled zirconia post and core, and zirconia crowns. The teeth were prepared to standardized specifications. The restored teeth were loaded to fracture at a 135° angle to their long axis, at a cross-head speed 0.5 mm/min, and the load (N) at failure was recorded. Statistical analysis was performed by SNK pairwise multiple comparisons (α=0.05). The mean fracture resistance of five groups as follows: 1019.30±139.01N for group A, 861.20±105.67N for group B, 833.70±100.56N for group C, 733.20±96.91N for group D, 698.00±99.90N for group E. The fracture resistance of restored teeth between group B and group C, group D and group E had no statistically significant difference(P>0.05). The fracture resistance of the rest pairwise group comparisons had statistically significant difference(P<0.05). Increasing the absence degree of ferrule, it was found that the fracture resistance decrease. The buccal and lingual ferrule were more important than mesial ferrule for enhanced fracture resistance. This in vitro study supports evidence that reserving the buccal and lingual ferrule is a key point to increase the fracture resistance of canines restored with one-piece milled zirconia post and core.

The effect of ferrule on the fracture mode of endodontically treated canines restored with fibre posts and metal-ceramic or all-ceramic crowns

ObjectivesThe aim of this study was to evaluate the fracture mode of endodontically treated canines (ETC) restored with glass-fibre posts (GFP) and either metal-ceramic (MC) or all-ceramic (AC) crowns, in the presence or absence of 2mm ferrule height. MethodsFifty recently extracted human maxillary canines were endodontically treated and randomly divided into 5 groups of 10 specimens each. Four groups (with or without ferrule) were restored with GFP, composite cores and either MC or AC crowns. The fifth group with intact ETC served as control. Teeth were loaded to fracture at a 135° angle to their long axis, at a cross-head speed 0.5mm/min. The fracture modes were divided through optical microscopy to repairable and irreparable. Statistical analysis was performed by means of the Fisher's Exact test. ResultsAll groups presented brittle fracture following bending deformation. Irreparable root fractures were the primary fracture mode independently of ferrule. The percentages (%) of repairable fractures were not statistically significant different amongst the MC and AC restored teeth independently of ferrule. However the 2mm ferrule was associated to a higher percentage of repairable fractures, especially in teeth restored with AC crowns. ConclusionsThe percentage (%) of repairable fractures was higher in all-ceramic compared to metal-ceramic ETC and in restorations with ferrule, although the differences were not statistically significant. Clinical significanceThis in vitro study supports evidence that neither the type of crown restoration nor the presence of ferrule affects statistically significantly the mode of fracture of ETC restored with GFP.

Effect of different ferrule designs on the fracture resistance and failure pattern of endodontically treated teeth restored with fiber posts and all-ceramic crowns

ObjectiveThis study investigated the effect of different ferrule heights on endodontically treated premolars.Materials and MethodsFifty sound mandibular first premolars were endodontically treated and then restored with 7-mm fiber post (FRC Postec Plus #1 Ivoclar-Vivadent) luted with self-polymerized resin cement (Multilink, Ivoclar Vivadent) while the coronal section was restored with hybrid composite core build-up material (Tetric Ceram, Ivoclar-Vivadent), which received all-ceramic crown. Different ferrule heights were investigated: 1-mm circumferential ferrule without post and core (group 1 used as control), a circumferential 1-mm ferrule (group 2), non-uniform ferrule 2-mm buccally and 1-mm lingually (group 3), non-uniform ferrule 3-mm buccally and 2-mm lingually (group 4), and finally no ferrule preparation (group 5). The fracture load and failure pattern of the tested groups were investigated by applying axial load to the ceramic crowns (n=10). Data were analyzed statistically by one-way ANOVA and Tukey’s post-hoc test was used for pair-wise comparisons (α=0.05).ResultsThere were no significant differences among the failure load of all tested groups (P<0.780). The control group had the lowest fracture resistance (891.43±202.22 N) and the highest catastrophic failure rate (P<0.05). Compared to the control group, the use of fiber post reduced the percentage of catastrophic failure while increasing the ferrule height did not influence the fracture resistance of the restored specimens.ConclusionsWithin the limitations of this study, increasing the ferrule length did not influence the fracture resistance of endodontically treated teeth restored with glass ceramic crowns. Insertion of a fiber post could reduce the percentage of catastrophic failure of these restorations under function.

Rethinking ferrule – a new approach to an old dilemma

The 'ferrule effect' is a long standing, accepted concept in dentistry that is a foundation principle for the restoration of teeth that have suffered advanced structure loss. A review of the literature based on a search in PubMed was performed looking at the various components of the ferrule effect, with particular attention to some of the less explored dimensions that influence the effectiveness of the ferrule when restoring severely broken down teeth. These include the width of the ferrule, the effect of a partial ferrule, the influence of both, the type of the restored tooth and the lateral loads present as well as the well established 2 mm ferrule height rule. The literature was collaborated and a classification based on risk assessment was derived from the available evidence. The system categorises teeth according to the effectiveness of ferrule effect that can be achieved based on the remaining amount of sound tooth structure. Furthermore, risk assessment for failure can be performed so that the practitioner and patient can better understand the prognosis of restoring a particular tooth. Clinical recommendations were extrapolated and presented as guidelines so as to improve the predictability and outcome of treatment when restoring structurally compromised teeth. The evidence relating to restoring the endodontic treated tooth with extensive destruction is deficient. This article aims to rethink ferrule by looking at other aspects of this accepted concept, and proposes a paradigm shift in the way it is thought of and utilised.

Teeth restored using fiber-reinforced posts: In vitro fracture tests and finite element analysis

In dentistry the restoration of decayed teeth is challenging and makes great demands on both the dentist and the materials. Hence, fiber-reinforced posts have been introduced. The effects of different variables on the ultimate load on teeth restored using fiber-reinforced posts is controversial, maybe because the results are mostly based on non-standardized in vitro tests and, therefore, give inhomogeneous results. This study combines the advantages of in vitro tests and finite element analysis (FEA) to clarify the effects of ferrule height, post length and cementation technique used for restoration. Sixty-four single rooted premolars were decoronated (ferrule height 1 or 2 mm), endodontically treated and restored using fiber posts (length 2 or 7 mm), composite fillings and metal crowns (resin bonded or cemented). After thermocycling and chewing simulation the samples were loaded until fracture, recording first damage events. Using UNIANOVA to analyze recorded fracture loads, ferrule height and cementation technique were found to be significant, i.e. increased ferrule height and resin bonding of the crown resulted in higher fracture loads. Post length had no significant effect. All conventionally cemented crowns with a 1-mm ferrule height failed during artificial ageing, in contrast to resin-bonded crowns (75% survival rate). FEA confirmed these results and provided information about stress and force distribution within the restoration. Based on the findings of in vitro tests and computations we concluded that crowns, especially those with a small ferrule height, should be resin bonded. Finally, centrally positioned fiber-reinforced posts did not contribute to load transfer as long as the bond between the tooth and composite core was intact.

Finite element analysis of maxillary central incisors restored with various post-and-core applications

The purpose of this study was to investigate the effect of rigidity of post core systems on stress distribution by the theoretical technique, finite element stress-analysis method. Three-dimensional finite element models simulating an endodontically treated maxillary central incisor restored with a zirconia ceramic crown were prepared and 1.5 mm ferrule height was provided. Each model contained cortical bone, trabecular bone, periodontal ligament, 4 mm apical root canal filling, and post-and-core. Six combinations of three parallel type post (zirconia ceramic, glass fiber, and stainless steel) and two core (Paracore and Tetric ceram) materials were evaluated, respectively. A 50 N static occlusal load was applied to the palatal surface of the crown with a 60� angle to the long axis of the tooth. The differences in stress transfer characteristics of the models were analyzed. von Mises stresses were chosen for presentation of results and maximum displacement and hydrostatic pressure were also calculated. An increase of the elastic modulus of the post material increased the stress, but shifted the maximum stress location from the dentin surface to the post material. Buccal side of cervical region (junction of core and crown) of the glass fiber post restored tooth was subjected to the highest stress concentration. Maximum von Mises stress in the remaining radicular tooth structure for low elastic modulus resin core (29.21 MPa) was slightly higher than that for high elastic modulus resin core (29.14 MPa) in case of glass fiber post. Maximum displacement of glass fiber post restored tooth was higher than that of zirconia ceramic or stainless steel post restored tooth. [J Kor Acad Cons Dent 34(4):324-332, 2009]

Influence of intraradicular post and crown ferrule on the fracture strength of endodontically treated teeth

The aim of this study was to investigate the fracture strength of endodontically treated teeth restored with different posts and variable ferrule heights. Sixty freshly extracted human canines were treated endodontically and randomly assigned to 6 groups (n=10), being restored with custom-made cast post-and-core (CP0 and CP3 groups), prefabricated post and composite resin core (PF0 and PF3 groups), and composite resin (CR0 and CR3 groups). The CP0, PF0 and CR0 groups presented no ferrule and the CP3, PF3 and CR3 presented 3 mm of coronal structure. All teeth were restored with full metal crowns. The fracture strength was measured in a universal testing machine at 45 degrees to the long axis of the tooth until failure. Data were analyzed statistically by 2-way ANOVA and Tukey's test (alpha=0.05). When the mean fracture strength values were compared (CP0 group - 820.20 N, CP3 group - 1179.12 N; PF0 group - 561.05 N; PF3 group - 906.79 N; CR0 group - 297.84 N; and CR3 group - 1135.15 N) there was statistically significant among the groups (p<0.05), except for the three groups with 3 mm of coronal remaining, which were similar to each other. The results of this study showed that the ferrule in crowns promoted significantly higher fracture strength in the endodontically treated teeth.

The finite element analysis of the effect of ferrule height on stress distribution at post-and-core-restored all-ceramic anterior crowns

The purpose of this study was to compare the effect of ferrule with different heights on the stress distribution of dentin and the restoration-tooth complex, using the finite element stress analysis method. Three-dimensional finite element models simulating an endodontically treated maxillary central incisor restored with an all-ceramic crown were prepared. Three-dimensional models were varied in their ferrule height (NF: no ferrule, 1F: 1-mm ferrule, and 2F: 2-mm ferrule). A 300-N static occlusal load was applied to the palatal surface of the crown with a 135 degrees angle to the long axis of the tooth. In addition, two post and core materials with different elastic modulus were evaluated. The differences in stress transfer characteristics of the models were analyzed. Maximum stresses were concentrated on force application areas (32.6-32.8 MPa). The stress values observed with the use of a 2-mm ferrule (14.1/16.8 MPa) were lower than the no-ferrule design (14.9/17.1 MPa) for both the glass fiber-reinforced and zirconium oxide ceramic post systems, respectively. The stress values observed with zirconium oxide ceramic were higher than that of glass fiber-reinforced post system. The use of a ferrule in endodontically treated teeth restored with an all-ceramic post-and-core reduces the values of von Mises stresses on tooth-restoration complex. At rigid zirconium oxide ceramic post system, stress levels, both at dentin wall and within the post, were higher than that of fiber posts.

Metal collars - are they serving any purpose?

The purpose of this study was to investigate the fracture resistance of endodontically treated teeth with uniform and non-uniform ferrule configurations. Root canal treatment and post space was performed in fifty extracted intact, non carious human maxillary central incisors and were divided into 5 groups of 10 specimen each i.e. Group I -- No contra bevel (No core ferrule), Group 11 - contra bevel <2mm(core ferrule <2mm), Group III - 2mm contra bevel (2mm core ferrule), Group I V - contra bevel >2mm (core ferrule >2mm). Group V - Non­uniform contra bevel (Non uniform core ferrule). Crown preparation was done in a standardized manner in all the specimen. Based on the groups varying core ferrule height was given in all the specimen. Wax patterns were made, invested and casted. Cast posts were then luted followed by crown cementation and then tested in universal testing machine at a cross head speed of 2.5mm/min and the load was applied to the lingual edge at 45° angle to the long axis of the tooth. It was concluded that contra-bevel / core ferrule does not further enhance the fracture resistance.

A finite element analysis of ferrule design on restoration resistance and distribution of stress within a root

To analyse the effect of ferrule height upon the mechanical resistance and stress distribution within a root to explain variations in the pattern of root fracture. An extracted, intact, caries free, maxillary right central incisor was scanned by laser and then reconstructed on a computer to produce a model of the tooth and associated periodontal ligament. A simulated post/core/crown restoration was constructed on conventional tooth preparations with various ferrules. The crown was loaded with a simulated 500 N force and the simulated displacement of components and the tensile and compressive stress within the tooth structure were recorded. Without a ferrule preparation, the simulated crown tilted to the labial and rotated distally. With increasing ferrule height the displacement and rotation of the crown reduced in conventional and crown-lengthening models with maximum reduction occurring when the ferrule height reached 1.5 mm. In ferrule models, higher levels of tensile stress developed in internal (by a factor of 8) and mid-root palatal (by a factor of 90) dentine at the cervical margin of the preparation. With an increase in ferrule height, the area of tensile stress within the palatal mid-dentine expanded towards the cervical margin. Similar patterns and stress values were recorded for the crown-lengthening models. The study confirms that a ferrule increases the mechanical resistance of a post/core/crown restoration. However a ferrule creates a larger area of palatal dentine under tensile stress that may be a favourable condition for a crack to develop. Crown-lengthening did not alter the levels or pattern of stress within compared with conventional ferrule preparations.

In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations

The in vitro effectiveness of a uniform circumferential ferrule has been established in the literature; however, the effect of a nonuniform circumferential ferrule height on fracture resistance is unknown. This in vitro study investigated the resistance to static loading of endodontically treated teeth with uniform and nonuniform ferrule configurations. Fifty extracted intact maxillary human central incisors were randomly assigned to 1 of 5 groups: CRN, no root canal treatment (RCT), restored with a crown; RCT/CRN, no dowel/core, restored with a crown; 2 FRL, 2-mm ferrule, cast dowel/core and crown; 0.5/2 FRL, nonuniform ferrule (2 mm buccal and lingual, 0.5 mm proximal), cast dowel/core and crown; and 0 FRL, no ferrule, cast dowel/core and crown. The teeth were prepared to standardized specifications and stored for 72 hours in 100% humidity prior to testing. Testing was conducted with a universal testing machine with the application of a static load, and the load (N) at failure was recorded. Statistical analysis was performed with a 1-way analysis of variance and the Tukey Honestly Significant Difference test (alpha=.05). The mode of fracture was noted by visual inspection for all specimens. There was strong evidence of group differences in mean fracture strength ( P <.0001). Following adjustment for all pairwise group comparisons, it was found that the lack of a ferrule resulted in a significantly lower mean fracture strength (0 FRL: 264.93 +/- 78.33 N) relative to all other groups. The presence of a nonuniform (0.5 to 2-mm vertical height) ferrule (0.5/2 FRL: 426.64 +/- 88.33 N) resulted in a significant decrease ( P =.0001) in mean fracture strength when compared with the uniform 2-mm vertical ferrule (2 FRL: 587.23 +/- 110.25 N), the group without RCT (CRN: 583.67 +/- 86.09 N), and the RCT-treated tooth with a crown alone (CRN/RCT: 571.04 +/- 154.86 N). The predominant mode of failure was an oblique fracture extending from the lingual margin to the facial surface just below the insertion of the tooth into the acrylic resin. The results demonstrated that central incisors restored with cast dowel/core and crowns with a 2-mm uniform ferrule were more fracture resistant compared to central incisors with nonuniform (0.5 to 2 mm) ferrule heights. Both the 2-mm ferrule and nonuniform ferrule groups were more fracture resistant than the group that lacked a ferrule.