Aim: To compare the fracture resistance of anterior teeth restored with either glass fiber post (GFP) and conventional lithium disilicate (LDS) crowns or endocrowns made of LDS or hybrid ceramics.
Materials and methods: A total of 21 central incisors with 2-mm ferrule and 1-mm shoulder finish line were applied in this investigation. The teeth were divided into three main groups (n = 7) according to the type of restoration used: PC glass fiber post (GFP) and e-max crown, EE (LDS endocrown), and VE (Vita-Enamic endocrown). Mechanical cyclic loading was conducted in a chewing simulator to simulate 6 months of clinical use. Fracture resistance and failure mode were assessed; further examination of fractured specimens was done with scanning electron microscopy.
Results:Post-hoc Tukey's test was performed to investigate the pairwise differences in fracture resistance among the three groups, and the results were p = 0.0452 between PC and VE groups, which is significant statistically. In contrast, p = 0.0615 between PC and EE groups, which is not significantly different. Chi-square test was made to analyze the results of mode of failure among the three groups, and there was a significant difference; p-value = 0.0289.
Conclusion: The LDS endocrowns show fracture resistance similar to that of GFP-supported full coverage LDS crowns, with advantage of more restorable mode of fractures. Vita-Enamic endocrowns, despite having fracture resistance lower than other groups, showed fracture resistance higher than the physiologic load, with restorable fractures more than both LDS endocrowns and GFP LDS crowns.
Clinical significance: For dental practitioners, endocrowns in damaged anterior endodontically treated teeth provide similar fracture resistance to GFP and full crowns, with the advantage of more restorable fractures if occurred.
Mannocci F, Bitter K, Sauro S, et al. Present status and future directions: The restoration of root filled teeth. Int Endod J 2022;55:1059–1084. DOI: 10.1111/iej.13796.
Silva CF, Cabral LC, de Oliveira MN, et al. The influence of customization of glass fiber posts on fracture strength and failure pattern: A systematic review and meta-analysis of preclinical ex-vivo studies. J Mech Behav Biomed Mater 2021;118:104433. DOI: 10.1016/j.jmbbm.2021.104433.
Silva-Sousa AC, Moris ICM, Barbosa AFS, et al. Effect of restorative treatment with endocrown and ferrule on the mechanical behavior of anterior endodontically treated teeth: An in vitro analysis. J Mech Behav Biomed Mater 2020;112:104019. DOI: 10.1016/j.jmbbm.2020.104019.
Saad KB, Bakry SI, AboElhassan RG. Fracture resistance of endodontically treated teeth, restored with two post-core systems in different post space diameters (in vitro study). BMC Oral Health 2023;23(1):992. DOI: 10.1186/s12903-023-03730-4.
Jurema ALB, Filgueiras AT, Santos KA, et al. Effect of intraradicular fiber post on the fracture resistance of endodontically treated and restored anterior teeth: A systematic review and meta-analysis. J Prosthet Dent 2022;128(1):13–24. DOI: 10.1016/j.prosdent.2020.12.013.
Pamato S, Ricci WA, Kuga MC, et al. The influence on fracture resistance of different composite resins and prefabricated posts to restore endodontically treated teeth. Polymers (Basel) 2023;15(1):236. DOI: 10.3390/polym15010236.
Kar S, Tripathi A, Trivedi C. Effect of different ferrule length on fracture resistance of endodontically treated teeth: An in vitro study. J Clin Diagn Res 2017;11(4):ZC49–ZC52. DOI: 10.7860/JCDR/2017/24669.9675.
Meng Q, Ma Q, Wang T, et al. An in vitro study evaluating the effect of ferrule design on the fracture resistance of endodontically treated mandibular premolars after simulated crown lengthening or forced eruption methods. BMC Oral Health 2018;18(1):83. DOI: 10.1186/s12903-018-0549-8.
Belleflamme MM, Geerts SO, Louwette MM, et al. No post-no core approach to restore severely damaged posterior teeth: An up to 10-year retrospective study of documented endocrown cases. J Dent 2017;63:1–7. DOI: 10.1016/j.jdent.2017.04.009.
Lien W, Roberts HW, Platt JA, et al. Microstructural evolution and physical behavior of a lithium disilicate glass–ceramic. Dent Mater 2015;31(8):928–940. DOI: 10.1016/j.dental.2015.05.003.
Vijayakumar BJ, Varadan P, Balaji L, et al. Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? – A systematic review of in-vitro studies. Biomater Investig Dent 2021;8(1):104–111. DOI: 10.1080/26415275.2021.1932510.
El-Malah EM, El-Aziz A, Hassan S. Evaluation of marginal accuracy and color stability of lithium disilicate laminate veneer compared to hybrid ceramic veneer. Al-Azhar J Dentistry 2019;6(3):285–290. DOI: 10.21608/adjg.2019.6942.1066.
Vafaee F, Firooz F, Heidari B, et al. A comparative study of flexural strength and fatigue resistance of 2 nanoceramic composite resin CAD/CAM blocks (Lava Ultimate and Vita Enamic) and a lithium disilicate glass ceramic (IPS e.max CAD). Biomed Pharmacol J 2017;10(1):51–58. DOI: 10.13005/bpj/1080.
Cinar S, Altan B, Akgungor G. Comparison of bond strength of monolithic CAD-CAM materials to resin cement using different surface treatment methods. J Adv Oral Res 2019;10(2):120–127. DOI: 10.1177/2320206819862062.
Thomas RM, Kelly A, Tagiyeva N, et al. Comparing endocrown restorations on permanent molars and premolars: A systematic review and meta-analysis. Br Dent J 2020;online ahead of print. DOI: 10.1038/s41415-020-2279-y.
Nawafleh N, Hatamleh M, Elshiyab S, et al. Lithium disilicate restorations fatigue testing parameters: A systematic review. J Prosthodont 2016;25(2):116–126. DOI: 10.1111/jopr.12376.
Badr AA, Abozaid AA, Wahsh MM, et al. Fracture resistance of anterior CAD/CAM nanoceramic resin endocrowns with different preparation designs. Braz Dent Sci 2021;24(3). DOI: 10.14295/bds.2021.v24i3.2384.
Mir M, Manan R. Endocrown: Rebirth of mutilated tooth. Int J Appl Dent Sci 2022;8(3):375–378. DOI: 10.22271/oral.2022.v8.i3d.1616.
He J, Zheng Z, Wu M, et al. Influence of restorative material and cement on the stress distribution of endocrowns: 3D finite element analysis. BMC Oral Health 2021;21:495. DOI: 10.1186/s12903-021-01865-w.
Zheng Z, He Y, Ruan W, et al. Biomechanical behavior of endocrown restorations with different CAD-CAM materials: A 3D finite element and in vitro analysis. J Prosthet Dent 2021;125(6):890–899. DOI: 10.1016/j.prosdent.2020.03.009.
Kasuya AVB, Favarão IN, Machado AC, et al. Development of a fiber-reinforced material for fiber posts: Evaluation of stress distribution, fracture load, and failure mode of restored roots. J Prosthet Dent 2020;123(6):829–838. DOI: 10.1016/j.prosdent.2019.04.026.
Kaur J, Sharma N, Singh H. In vitro evaluation of glass fiber post. J Clin Exp Dent 2012;4(4):e204–e209. DOI: 10.4317/jced.50737.
Ramírez-Sebastià A, Bortolotto T, Cattani-Lorente M, et al. Adhesive restoration of anterior endodontically treated teeth: Influence of post length on fracture strength. Clin Oral Investig 2014;18:545–554. DOI: 10.1007/s00784-013-0978-3.
Güngör MB, Bal BT, Yilmaz H, et al. Fracture strength of CAD/CAM fabricated lithium disilicate and resin nano ceramic restorations used for endodontically treated teeth. Dent Mater J 2017;36(2):135–141. DOI: 10.4012/dmj.2016-017.
Santos-Filho PCF, Veríssimo C, Soares PV, et al. Influence of ferrule, post system, and length on biomechanical behavior of endodontically treated anterior teeth. J Endod 2014;40(1):119–123. DOI: 10.1016/j.joen.2013.09.034.
Hofsteenge JW, Gresnigt MMM. The influence of dentin wall thickness and adhesive surface in post and core crown and endocrown restorations on central and lateral incisors. Oper Dent 2021;46(1):75–86. DOI: 10.2341/19-261-L.
Alghalayini S, Ebeid KK, Aldahrab A, et al. Fracture load of nano-ceramic composite material for anterior endocrown restorations. Braz Dent Sci 2020;23(1):9. DOI: 10.14295/bds.2020.v23i1. 1853.
De Souza FA, Cumerlato CBF, Feltrin PP, et al. Fracture strength and failure load of CAD/CAM fabricated endocrowns performed with different designs. Braz J Oral Sci. 2022;22:e237338. DOI: 10.20396/bjos.v22i00.8667338.
Kanat-Ertürk B, Saridağ S, Köseler E, et al. Fracture strengths of endocrown restorations fabricated with different preparation depths and CAD/CAM materials. Dent Mater J 2018;37(2):256–265. DOI: 10.4012/dmj.2017-035.
Dejak B, Młotkowski A. Strength comparison of anterior teeth restored with ceramic endocrowns vs custom-made post and cores. J Prosthodont Res 2018;62(2):171–176. DOI: 10.1016/j.jpor.2017. 08.005.
Dartora G, Pereira GKR, de Carvalho RV, et al. Comparison of endocrowns made of lithium disilicate glass-ceramic or polymer-infiltrated ceramic networks and direct composite resin restorations: Fatigue performance and stress distribution. J Mech Behav Biomed Mater 2019;100:103401. DOI: 10.1016/j.jmbbm.2019.10 3401.
Munoz A, Zhao Z, Paolone G, et al. Flexural strength of CAD/CAM lithium-based silicate glass–ceramics: A narrative review. Materials (Basel) 2023;16(12):4398. DOI: 10.3390/ma16124398.
Zarone F, Sorrentino R, Apicella D, et al. Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: A 3D static linear finite elements analysis. Dent Mater 2006;22(11):1035–1044. DOI: 10.1016/j.dental.2005.11.034.