Effect of Restoration Method on Fracture Resistance of Endodontically Treated Teeth with Radicular Cracks
Article Sidebar
Main Article Content
Abstract
Objective: To compare the fracture resistance of radicular cracks obturated with gutta-percha and restored by using dual-cured resin composite or a fiber-reinforced composite post placed 2 mm apical to the cracks.
Materials and Methods: 30 Bovine teeth were decoronated to obtain a standardized root length of 12 mm. Longitudinal cracks were simulated using a hammer and chisel, and only roots presenting a single crack line measuring 4-5 mm on the external surface were selected. Root canals were prepared and obturated with gutta-percha. The specimens were divided into three groups. Group 1, obturated with gutta-percha without additional restoration; Group 2, restored with dual-cured resin composite placed 2 mm apical to the cracks and Group 3, restored with a fiber-reinforced composite post placed 2 mm apical to the cracks. Fracture resistance testing was performed using a Universal Testing Machine. A compressive force was applied centrally over the canal opening until fracture occurred. The maximum force (newton) and fracture patterns were recorded.
Results: The highest mean compressive force was observed in the fiber-reinforced composite post group (717.753±72.44 N), followed by the dual-cured resin composite group (680.308±51.69 N). The gutta-percha group demonstrated the lowest value (207.165±37.28 N). One-way ANOVA and Tukey’s HSD test revealed statistically significant differences between the gutta-percha group and the other two groups (p<0.05). However, no significant difference was found between the dual-cured resin composite group and the fiber-reinforced composite post group (p>0.05).
Conclusion: Restoration of radicular cracks by using dual-cured resin composite and fiber-reinforced composite post significantly improved fracture resistance compared with gutta-percha. However, no significant differences were found between these two restoration methods.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles, data, content, images, and other materials published in the Khon Kaen University Dental Journal are the exclusive copyright of the Faculty of Dentistry, Khon Kaen University. Any individual or organization wishing to reproduce, distribute, or use all or any part of the published materials for any purpose must obtain prior written permission from the Faculty of Dentistry, Khon Kaen University.
References
Rivera E, Walton R. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. Am Assoc Endodontists Colleagues for Excellence News Lett. 2008;2:1-19.
Ricucci D, Siqueira Jr JF, Loghin S, Berman LH. The cracked tooth: histopathologic and histobacteriologic aspects. J Endod. 2015;41(3):343-52.
Khovidhunkit S, Songmanee S. Prevalence of cracked tooth in a group of patients at the Faculty of Dentistry, Mahidol University. M Dent J. 2014;34(3):234-42.
Liao WC, Tsai YL, Chen KL, Blicher B, Chang SH, Yeung SY, et al. Cracked teeth: Distribution and survival at 6 months, 1 year and 2 years after treatment. J Formos Med Assoc. 2022;121(1):247-57.
Hiatt WH. Incomplete crown-root fracture in pulpal-periodontal disease. J Periodontol. 1973;44(6):369-79.
Dewi A, Yeh Y, Vinaikosal N, Lauwakul P. Management of cracked tooth with deep cracks and periodontal defect: A 1-year follow-up. Chiang Mai Dent J. 2020;41(2):175-86.
Davis MC, Shariff SS. Success and survival of endodontically treated cracked teeth with radicular extensions: a 2-to 4-year prospective cohort. J Endod. 2019;45(7):848-55.
Araújo LP, da Rosa WL, de Araujo TS, Immich F, da Silva AF, Piva E. Effect of an intraorifice barrier on endodontically treated teeth: A systematic review and meta-analysis of in vitro studies. Biomed Res Int. 2022;2022:8385200.
Nagas E, Uyanik O, Altundasar E, Durmaz V, Cehreli ZC, Vallittu PK, et al. Effect of different intraorifice barriers on the fracture resistance of roots obturated with Resilon or gutta-percha. J Endod. 2010;36(6):1061-3.
Kusrisomsup P, Muangmingsuk A, Senawongse P. Fracture resistance of endodontically treated teeth restored with dual-cured resin composite within root canal at different depths. M Dent J. 2014;34(1):28-36.
Hunter A, Feiglin B, Williams J. Effects of post placement on endodontically treated teeth. J Prosthet Dent. 1989;62(2):166-72.
Çapar İD, Uysal B, Ok E, Arslan H. Effect of the size of the apical enlargement with rotary instruments, single-cone filling, post space preparation with drills, fiber post removal, and root canal filling removal on apical crack initiation and propagation. J Endod. 2015;41(2):253-6.
Ree M, Schwartz RS. The endo-restorative interface: current concepts. Dent Clin North Am. 2010;54(2):345-74.
Chauhan P, Garg A, Mittal R, Kumar H. A comparative evaluation of fracture resistance of endodontically treated teeth using four different intraorifice barriers: An in vitro study. J Conserv Dent. 2019;22(5):420-4.
Thota KS, Bhavya KL, Sreeha K, Deshpande S, Javvadi J, Avina A. Comparative evaluation of reinforcing effect of three different intra-orifice barriers on pericervical dentin of endodontically treated teeth: An in vitro study. J Conserv Dent. 2024;27(12):1276-9.
Aboobaker S, Nair BG, Gopal R, Jituri S, Veetil FRP. Effect of intra-orifice barriers on the fracture resistance of endodontically treated teeth–an ex-vivo study. J Clin Diagn Res. 2015;9(2):17-20.
Yavari HR, Samiei M, Shahi S, Aghazadeh M, Jafari F, Abdolrahimi M, et al. Microleakage comparison of four dental materials as intra-orifice barriers in endodontically treated teeth. Iran Endod J. 2012;7(1):25-30.
Pest LB, Cavalli G, Bertani P, Gagliani M. Adhesive post-endodontic restorations with fiber posts: push-out tests and SEM observations. Dent Mater J. 2002;18(8):596-602.
Jang JH, Park SJ, Min KS, Lee BN, Chang HS, Oh WM, et al. Stress behavior of cemented fiber-reinforced composite and titanium posts in the upper central incisor according to the post length: Two-dimensional finite element analysis. J Dent Sci. 2012;7(4):384-9.
Jain A, Shah NC, Kumar M, Ishwar S, Purkayastha DD, Mishra D, et al. Stress distribution pattern in two different no-post systems in endodontically treated maxillary central incisors: A three-dimensional finite element analysis. J Conserv Dent. 2024;27(6):572-6.
Boonrawd N, Rungsiyakull P, Rungsiyakull C, Louwakul P. Effects of composite resin core level and periodontal pocket depth on crack propagation in endodontically treated teeth: An extended finite element method study. J Prosthet Dent. 2022;128(2):195.e1-7.
Miguez P, Pereira P, Atsawasuwan P, Yamauchi M. Collagen cross-linking and ultimate tensile strength in dentin. J Dent Res. 2004;83(10):807-10.
Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011;44(9):817-26.
Zuli TAB, Guedes OA, Gonçalves GFZA, da Silva Júnior AR, Borges ÁH, Aranha AMF. Effect of post space preparation drills on the incidence of root dentin defects. Restor Dent Endod. 2020;45(4):e39.
Bhagat A, Mittal L, Mogla S, Kaur T, Dheeraj M, Marwah G. Impact of Root Dentin Thickness on the in vitro Compressive Strength of Teeth treated with Recent Post and Core Systems. J Contemp Dent Pract. 2017;18(11):1065-70.
Kuçi A, Azizi B. Understanding the Effects of Root Canal Treatment on Dentinal Cracks - A Narrative Review. Int J Biomed. 2025;15(1):24-30.
Chellapilla PK, Boddeda MR, Jyothi M, Uppalapati LV, Konagala RK, Dasari L. Influence of obturating techniques on root dentin crack propagation: A micro-computed tomography assessment. J Conserv Dent. 2021;24(1):72-6.
Kishen A. Mechanisms and risk factors for fracture predilection in endodontically treated teeth. Endod Topics. 2006;13(1):57-83.
Lin GSS, Ghani NRNA, Noorani TY. The existence of butterfly effect and its impact on the dentinal microhardness and crack formation after root canal instrumentation. Odontology. 2021;109(3):672-8.
Sodvadiya UB, Bhat GS, Shetty A, Hegde MN, Shetty P. The “Butterfly Effect” and Its Correlation to the Direction of the Fracture Line in Root Dentin. J Endod. 2021;47(5):787-92.
Fonseca R, Haiter-Neto F, Carlo H, Soares C, Sinhoreti M, Puppin-Rontani R, et al. Radiodensity and hardness of enamel and dentin of human and bovine teeth, varying bovine teeth age. Arch Oral Biol. 2008;53(11):1023-9.
Soares F, Follak A, Da Rosa L, Montagner A, Lenzi T, Rocha R. Bovine tooth is a substitute for human tooth on bond strength studies: A systematic review and meta-analysis of in vitro studies. Dent Mater. 2016;32(11):1385-93.
Tanaka JLO, Medici Filho E, Salgado JAP, Salgado MAC, Moraes LC, Moraes MEL, et al. Comparative analysis of human and bovine teeth: radiographic density. Braz Oral Res. 2008;22(4):346-51.
Brown W, Christofferson P, Massler M, Weiss M. Postnatal tooth development in cattle. Am J Vet Res. 1960;21:7-34.
de Dios Teruel J, Alcolea A, Hernández A, Ruiz AJ. Comparison of chemical composition of enamel and dentine in human, bovine, porcine and ovine teeth. Arch Oral Biol. 2015;60(5):768-75.
Castanho GM, Marques MM, Marques JB, Camargo MA, Cara AA. Micromorphological and hardness analyses of human and bovine sclerotic dentin: a comparative study. Braz Oral Res. 2011;25(3):274-9.
Yasa E, Arslan H, Yasa B, Akcay M, Alsancak M, Hatirli H. The force required to fracture endodontically roots restored with various materials as intra-orifice barriers. Niger J Clin Pract. 2017;20(10):1237-41.
Jamani K, Harrington E, Wilson H. Rigidity of elastomeric impression materials. J Oral Rehabil. 1989;16(3):241-8.
Wang SJ, Wang SY. In vivo measurement of the elastic modulus of the human periodontal ligament. Med Eng Phys. 2003;25(2):163.
Linsuwanont P, Kulvitit S, Santiwong B. Reinforcement of simulated immature permanent teeth after mineral trioxide aggregate apexification. J Endod. 2018;44(1):163-7.
Coelho-de-Souza FH, Rocha AC, Rubini A, Klein-Júnior CA, Demarco FF. Influence of adhesive system and bevel preparation on fracture strength of teeth restored with composite resin. Braz Dent J. 2010;21(4):327-31.
Silva GR, Silva NR, Soares PV, Costa AR, Fernandes-Neto AJ, Soares CJ. Influence of different load application devices on fracture resistance of restored premolars. Braz Dent J. 2012;23(5):484-9.
Soliman P, Roshdy N, Fouda M. Assessment of fracture resistance in teeth with simulated perforating internal root resorption cavities repaired with biodentine, retro MTA and portland cement (A comparative in vitro study). Acta Sci Dent Sci. 2021;5(8):85-92.
Ordinola-Zapata R, Fok A. Research that matters: debunking the myth of the “fracture resistance” of root filled teeth. Int Endod J. 2021;54(3):297-300.
Schmoldt SJ, Kirkpatrick TC, Rutledge RE, Yaccino JM. Reinforcement of simulated immature roots restored with composite resin, mineral trioxide aggregate, gutta-percha, or a fiber post after thermocycling. J Endod. 2011;37(10):1390-3.
Almanie D, Alaathy S, Almohaimede EA. Fracture resistance of roots filled with bio-ceramic and epoxy resin-based sealers: In vitro study. Eur Endod J. 2020;5(2):134-7.
