Fracture resistance of thin wall endodontically treated teeth without ferrules restored with various techniques

Objective To evaluate the fracture resistance and failure characteristics of simulated thin wall endodontically treated teeth without ferrules restored with various techniques. Materials and methods Forty-eight human mandibular single-root canal premolars were decoronated and endodontically treated. The 1 mm thick remaining root canal dentin was prepared. The roots were randomly divided into four groups of 12 roots according to the following post and core reconstruction techniques: direct resin composite post and core (CP), multiple fiber posts and resin composite core (FP), CAD/CAM anatomical post and core (AP), and metal cast post and core (MP). Full metal crowns were cemented to the cores. All specimens were subjected to thermocycling for 5000 cycles and submitted to axial compression until failure at a 45 degrees angle using a universal testing machine. The failures were classified into one of the followings: post and/or core fractures, root fractures, and root fractures combined with post and/or core fractures. Results Average failure loads of groups CP, FP, AP, and MP were 360.0, 655.2, 402.7, and 856.1 N, respectively. MP provided the highest failure load, which was significantly higher than those of the other groups (p < 0.05). FP was second, being inferior to MP with a significance level of p = 0.039. CP exhibited the least failure load, and it was not significantly different from the AP group (p > 0.05). Root fractures were the major failure mode for most of the specimens except the CP group, in which composite fractures at the cervical level were commonly observed. Conclusion Metal cast post and core provided the highest fracture resistance for reconstruction of a thin wall in endodontically treated teeth without ferrules, followed by multiple fiber posts and resin composite core. The milled anatomical post and core and a direct resin composite post and core provided significantly lower fracture resistance. Clinical significance Metal cast posts and core and multiple fiber posts with resin composite core techniques were effective for restoring severely compromised endodontically treated teeth.