ENDODONTOLOGY Volume: 26 Issue 2 December 2014

ORIGINAL RESEARCH

The viability of current obturating systems as Replacement

Endodontic Monoblocks A 3 Dimensional Finite Element Analysis
Sonali Sharma
_______________________________________

Conservative dentistry & Endodontics, Army Dental Centre(R & R), Delhi 110010
E-mail: sonaliendo@gmail.com

Abstract:
Aim: This study was aimed to evaluate the viability of current obturating systems as replacememt endodontic monoblocks by
three dimensional finite element analysis (FEA). The mechanical performance of central incisors obturated by different types of
obturating materials was evaluated under three different loading conditions.
Materials and Method: The model of the tooth and supporting structures was designed, based on material properties and
features obtained from previous studies and review of literature. The tooth was obturated by three different obturating systems
and three different loading conditions were separately considered i.e inclined load - 70 N at 45 degree to simulate masticatory
forces, vertical load of 100 N applied on the incisal edge of crown to simulate bruxism and horizontal load of 100 N to simulate
external traumatic forces. The FE stress analysis was performed with the ANSYS, a commercial FEM package.
Results: The results of finite element analysis are expressed as stresses, i.e tensile compressive, shear or a combination known as
Von Mises stresses. These stresses became increasingly more complex as additional interfaces with varying modulus of elasticity
were incorporated from the primary to the tertiary monoblocks.
Conclusion And Clinical Relevance: Replacement endodontic monoblocks created in the root canal spaces may be classified as
primary, secondary, or tertiary depending on the number of interfaces present between the bonding substrate and the bulk
material core. Within the limitations of the study it can be inferred that the closer the elasticity of modulus of the replacement
monoblock to dentin, the lower the stresses generated. The viability of integrating this emerging concept in clinical situations is
highlighted and the search for ideal obturating materials for reinforcing the root canal may be viewed as an ideal goal.
Keywords: Monoblocks Primary, Secondary, Tertiary, Finite Element Analysis, Von Mises stresses, Modulus of Elasticity

depending on the number of interfaces present

between the bonding substrate and the bulk material
core. A primary monoblock has only one interface
that extends circumferentially between the material
and the root canal wall. Secondary monoblocks are
those that have two circumferential interfaces, one
between the cement and dentin and the other between
the cement and the core material. Tertiary
monoblocks are those in which a third
circumferential interface is introduced between the
bonding substrate and the obturating material.1
Due to immense disparity in results of in
vitro studies predicting fracture potentiality, today
investigators rely on finite element methods for a
predictive outcome. When finite element analysis
(FEA) is compared with laboratory testing, it offers
several advantages. Experimental studies often
cannot control the variables that are present
clinically; in addition, direct measurement of stress in
the root canal wall is impossible. The FEA can
circumvent the limitations of in vitro stress analysis
studies and clinical studies and thus is an important
analysis tool. 4-7

Introduction:
Endodontic rehabilitation is a complex and
demanding procedure as the stress distribution within
the root canal system is multiaxial, non-uniform and
depends on the extent, magnitude and direction of the
applied external load. The tooth structure becomes
weaker with the challenges of dental caries, abrasion
and trauma. Practicing the concept of caries free,
straight-line access in nonvital endodontics further
weakens the tooth structure. Thus, in such cases, it is
mandatory that a rehabilitative treatment option is
available which will not only restore the tooth, but
also reinforce the structurally compromised tooth.
The search for such an ideal material has given rise to
the concept of endodontic monoblocks. 1-3
The term monoblock literally means a single
unit. The advancement in field of dental adhesion has
led to birth of this concept in endodontics. Two
prerequisites are simultaneously required for a
monoblock to function successfully as a
mechanically homogenous unit. Firstly, the materials
that constitute a monoblock should have the ability to
bond strongly and mutually to one another, as well as
to the substrate that the monoblock is intended to
reinforce. Secondly, these materials should have a
modulus of elasticity that is similar to that of the
substrate.1
Replacement endodontic monoblocks may
be classified as primary, secondary, or tertiary

Materials and Method:

The first step of any finite element analysis
is to divide the actual geometry of the structure using
a collection of discrete portions called finite
elements. The elements are joined together by shared
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The Viability of Current Obturating Systems as Replacement Endodontic

Monoblocks A 3 Dimensional Finite Element Analysis
nodes. The collection of nodes and finite elements is
known as the mesh. The model of the maxillary
central incisor and supporting structures was
designed, based on material properties and features
obtained from previous studies. 3-13 (Table 1)

Table 1 Overview of material properties

Four different models were developed (FIG 1& 2)

MODEL 1: Natural Tooth

MODEL 2: Primary Replacement Monoblock:
Pulpless tooth was restored with MTA, and restored
with composite restoration and a ceramic crown.
MODEL 3: Secondary Replacement Monoblock:
Pulpless tooth was obturated with Resilon, and
restored with composite restoration and a ceramic
crown.
MODEL 4: Secondary Replacement Monoblock:
Pulpless tooth was obturated with Endorez and
restored with composite restoration and a ceramic
crown.

Fig 1: Model build-up of different obturating

material

Each Model was meshed (FIG 3a, 3b) and then

subjected to three different loading conditions
i) An inclined load of 70 N was applied at 45
degree, to simulate masticatory forces.
ii) A vertical load of 100 N was applied on the
incisal edge of crown to simulate bruxism.
iii) A horizontal load of 100 N was applied labially
to simulate external traumatic forces.
As a boundary condition, no displacements
were allowed for the nodes along the bottom end line
of the models. The FE stress analysis was performed
with the FE software program. (ANSYS). The results
of FEA are expressed as stresses distributed in the
structure under investigation. These stresses are a
combination of tensile, compressive shear stress
known as Von Mises stresses. Its a failure criteria
applied to ductile materials. Von Mises stresses
depend on the entire stress field and are a widely
used indicator of the possibility of damage
occurrence. 2-7

Fig 2a. The meshing was carried out converting

physical model to FEM model of nodes and
elements
Fig 2b. Diagrammatic representation of meshing

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The Viability of Current Obturating Systems as Replacement Endodontic

Monoblocks A 3 Dimensional Finite Element Analysis
increased concentration of stress pattern. (Table 2,
Fig 5)

Fig 3: Stress Pattern Under inclined loading of 70N

FIG 4: Stress Pattern Under vertical loading of

100N

Results:
On application of an inclined load of 70 N, it
was observed that for natural tooth the stresses
generated were transmitted through the tooth and
periodontal ligament to the surrounding bone. For the
MTA model, the stresses were more in apical third.
For the resilon model, the highest value of internal
stress was in proximity of the outer dentin surface, as
in natural tooth. The stress concentration was
maximum on the apical third of the root. For endorez
model the stresses were more at the interfaces and
forces were disseminated more in apical region and
over the root and cortical bone (Table 2, Fig 3)
In the case of a vertical 100 N load, the
stresses generated during bruxism were more on the
incisal edges in the natural tooth model. The MTA
rehabilitated model showed equidistribution of
stresses along root surfaces and greatest stress
concentration was found at apical third of the root. In
the resilon model, there was also a concentration of
forces at the root tip and cervical margins of the
crown. This can be due to the fact that the core
material has a relatively lower elastic modulus
compared to surrounding materials (ceramic crown
and dentin). With the endorez model, the stresses
were more at the interfaces especially in the coronal
third and middle third.(Table 2, Fig 4)
On application of horizontal load of 100 N,
the natural tooth showed concentration of stresses on
the labial surfaces mainly on crown root junction, the
MTA model showed more stresses at the interfaces
especially at cervical region both labially and
palatally. The resilon model showed concentration on
apical and middle third region labially but the stress
distribution pattern was similar to natural tooth. The
endorez model showed increased concentration of
stresses at the interfaces and also at the cervical
margin of crown. The labial alveolar plate also had

Fig 5: Stress Pattern under horizontal loading of

100N

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The Viability of Current Obturating Systems as Replacement Endodontic

Monoblocks A 3 Dimensional Finite Element Analysis
studied as a primary endodontic monoblock instead
of hydron. MTA does not adhere to the dentin
surfaces but mechanically binds to the root. MTA is
used as an orthograde root filling material in cases of
apexification, hence it can be considered as a
contemporary primary monoblock.1 In this study, it
was found that the stresses induced are more in apical
third.
The combined use of a core material and a
cement/sealer in endodontic obturations introduces
additional interfaces into a monoblock. A secondary
monoblock that is classically perceived in the
restorative and endodontic literature is the fibre post
and core system. 1-5,8 Studies have shown that zinc
phosphate cement or glass ionomer cement when
used for cementation of post and core systems were
less effective than dentin adhesives and resin cements
in strengthening roots owing to the difference in their
modulus of elasticity with that of dentin .13-15,18-19
Hence in this study we have used resin sealer for
bonding along with self etch bonding system. The
material selected to demonstrate secondary
monoblock was Resilon. Resilon is a bondable
obturating material which uses a methacrylate based
sealer and self etching primer for conditioning root
dentin. When all components have similar elastic
moduli there is a uniform stress distribution and
lowered interfacial stress and failure. This
phenomenon has been termed "monoblock," Due to
two interfaces, one between the primed root surface
and sealer and the other between sealer and resilon,
it falls in the group of secondary monoblock. Resilon
along with epiphany system has been referred to as
monoblock system and has shown favourable fracture
resistance. 8, 20-21 In the present study it was
demonstrated that as the number of interface
increases the stresses also increase but the
distribution of stresses were similar to that of natural
tooth. This is in confirmation with other studies.1,8
Tertiary monoblocks are those in which a
third circumferential interface is introduced between
the bonding substrate and the obturating material.
Obturating material like Endorez is a conventional
gutta percha coated with a proprietary resin coating.
In this system since the root dentin is not primed with
an adhesive, the adhesion depends on the penetration
of the sealer into the dentinal tubules. In the present
study it was found that due to an additional interface
there is an increase in stresses generated as compared
to the other groups. This is in confirmation with
other studies 1,8

Table 2: Von Mises Stresses Generated

Discussion:
Root canal treated teeth are more prone to
fracture due to loss of tooth structure.1,5-6 The
strength of an endodontically treated tooth is directly
proportional to the amount of sound tooth structure
remaining.6-16 In an attempt to understand the
distribution of stresses in the tooth a variety of
methods have been used to predict tissue response to
load. These include theoretical mathematical
techniques, photoelastic systems and laser
holographic interferometry.
However, these
techniques have the disadvantage of only examining
surface stress, whilst having the added problem of
usually being supported by poor validation systems
as judged by the current standards. 3,8
The Finite Element Method (FEM) is a
computerized numerical iteration technique used to
determine the stress and displacements through a
predetermined model. The method was introduced in
late sixties in the aerospace industry and was applied
in dentistry in the early seventies. The FEM can be
applicable to the problem of the stress strain levels
induced in internal structures. The distribution of
various materials of the tooth structure does not show
any symmetry. Therefore a three dimensional
modeling with the actual dimension must be
preferred for a reliable analysis. 3, 9-15
During 1970s, when path breaking research
was surfacing and redefining our concepts and
understanding of dental adhesion, it was then
Hydron, a 2 hydroxylethyl methacrylate containing
root canal filling material was introduced. It
promised to be a complete en masse root canal filling
alternative.
Subsequent independent studies
demonstrated that Hydron-filled root canals exhibited
extensive leakages. 1 Hence, in this study MTA was

Conclusion:
Within the limitations of the study it can be
inferred that as the number of interfaces increase the
stresses generated also increase. Thus primary
monoblocks have lower magnitude of stresses as
compared to secondary and tertiary monoblocks. The
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The Viability of Current Obturating Systems as Replacement Endodontic

Monoblocks A 3 Dimensional Finite Element Analysis
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closer the elasticity of modulus of the replacement

monoblock to dent in the lower the stresses
generated. Although the concept of creating
mechanically homogenous units with root dentin is
excellent in theory, accomplishing these ideal
monoblocks in the root canal space is an ongoing
challenge to the clinician. MTA as an obturating
material is discussed for academic purpose as it does
not adhere to the root dentin and it is used as a root
filling material only in apexification cases. Hence
resilon could serve as an ideal monoblock material in
mature roots because the stress distribution pattern is
similar to that of natural teeth.
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