Core materials

Definition:
substructure, which replaces missing coronal tooth structure and retains the
final restoration.
Functions of Core built up:
1. To support and preserve the residual tooth structure.
2. To provide retention to final restoration,
3. Provide resistance to the displacement of final resto.

Ideal Requirements of a core material:

1. Adequate compressive strength and flexural strength, to resist intraoral
forces
2. bonding to remaining tooth structure, and post.
3. Thermal coefficient of expansion and contraction similar to tooth structure.
4. Dimensional stability.
5. Resistance to leakage of oral fluids at the core-tooth interface.
6. Minimal potential for water absorption.
7. Esthetically accepted.
8. Inhibition of dental caries.
9. Biocompatibility.
10.Ease of manipulation.
11.Reasonable Cost

Classification of core materials:

A. According to Type of the material:
1. Metallic.
2. Resinous.
3. Ceramic.
B. According to mode of construction:
a) Direct:
1. Amalgam core.
2. Resin based composite core.
3. Glass ionomer core.
4. Polyacid-modified composite resins (Compomers).
5. Fibre-reinforced core materials.

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b) Indirect:
1. Cast gold alloy core.
2. Ceramic core.

a) Direct core materials:

a.1) Amalgam core:

Advantages:
1. High compressive strength, can be used in stress bearing areas.
2. High sealing ability, that improves with time as a result of deposition of
corrosion products.
3. Its coefficient of thermal expansion is similar to that of tooth structure.
4. Ease of manipulation.
5. Low cost.

Disadvantages:
1. Brittle…. having low tensile strength.
2. It doesn’t bind to tooth structure….. needs macromechanical means of
retention to tooth structure & adequate coronal tooth structure.
3. prolonged setting time…… it is difficult to prepare tooth immediately after
placement of the core material.
4. Non-esthetic.
5. Amalgam toxicity….. there is no scientific evidence to support this claim.

indication:
molar teeth with sufficient coronal tooth structure

a.2)Resin composite core

composed of:
1. organic polymer matrix,
2. inorganic fillers
3. coupling agent (organosilane) that bonds the filler to the matrix.

classification:
1. chemically cured

disadvantages:

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  increased air incorporation during mixing,
 inability to control working time

2. light cured

advantages:

 less air incorporation

 ability to control working time
 less discoloration
 higher strength

3. dual cured
 overcame the problem of limited curing depths

Advantages:
1. bonding to tooth structure, and fiber post forming a monoblock.
2. Good Esthetics
3. good strength
4. Low solubility.

Disadvantages:
1. Polymerization shrinkage… microleakage… discoloration and recurrent
caries. (Solved by incremental packing)
2. High coefficient of thermal expansion and contraction of these materials…
Microleakage… discoloration and recurrent caries.
3. Depth of curing. (solved by Incremental packing + dual cured composites)
4. Hydroscopic expansion due to water adsorption
5. incompatible with Zinc oxide root canal sealer. (ZOE sealer has to be
properly removed from pulp chamber)
6. Technique sensitive, needs complete assurance of moisture control to avoid
microleakage.

indication:

anterior and posterior teeth, when isolation is assured

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 Flowable composite (Bulk fill technique in 4mm increment):

Advantages:

1. faster, easier technique than incremental layering for posterior

restorations.
2. Better flowability + self-adapting… ideal cavity adaptation.
3. Low shrinkage stresses… better long term marginal integrity
4. High radioopacity… accurate diagnosis of recurrent caries

a.3) Glass ionomer:

composed of:
 inorganic fluoroaluminosilicate (FAS) glass powder
 polyacid, water and tartaric acid.

a.3.1) Conventional glass ionomer:

Advantages:
1. Anticariogenic property as a result of fluoride release.
2. bonding to tooth structure
3. coefficient of thermal conductivity similar to tooth structure.
4. Biocompatible.
5. Translucent.

Disadvantages:
1. Low mechanical properties (low modulus of elasticity, low tensile and
compressive strengths, low wear resistance).
2. Low resistance to fracture.
3. High solubility.
4. short working time and long setting time.
indication:

conventional glass ionomer cement as a core material, should be avoided.

a.3.2) Metal-reinforced glass ionomers (MRGI):

composition: Silver-tin metal alloys incorporated as metallic fillers with
glass powder, to increase strength properties.

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 advantages: no advantages over conventional glass-ionomers.
Disadvantages:
 Poorer adhesion to tooth structure.
 Decrease in fluoride release property.

a.3.3) Resin-modified glass-ionomers (RMGI):

Composition:
 powder similar to that of glass-ionomers
 chemically- or light-curable monomer (HEMA) in the liquid

Advantages:
1. It has better mechanical properties.
2. Chemical bonding to tooth structure without a bonding agent
3. coefficient of thermal expansion and contraction close to that of tooth
structure… minimizing the microleakage .
4. maintained fluoride-release property.
5. Considerable working time.
6. Easy manipulation.

Disadvantages:
1. greater degree of shrinkage upon polymerization
2. lower rigidity compared to that of composites.
3. lower strength than natural tooth structure.
4. not translucent.
5. Water sorption Due to the hydrophilic HEMA… increased microleakage.
a.4) Polyacid-modified composite resins (Compomers):
Advantages:
1. mechanical properties better than those of glass-ionomer and resin-
modified glass-ionomer cements.
2. Good esthetic properties of composites.
3. rapid rate of water sorption… rapid compensation for polymerization-
shrinkage… reduction of marginal gapping.
4. Durability
5. Fluoride-release

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 Disadvantages:
1. mechanical properties inferior to those of composite resins.
2. Excessive hygroscopic expansion .
3. not self-adhesive… requiring an adhesive to bond to the tooth structure.

a.5) Fibre-reinforced core materials:

 It is a recent dual-cured, fibre-reinforced core material.
 They are used in conjunction with core formers, mixed in a double helix
dispenser, leading to a bubble-free mix, with excellent handling properties.

b) Indirect core materials:

b.1) Cast gold core:

Advantages:
1. High strength.
2. Low solubility.
3. coefficient of thermal expansion similar to that of tooth substance.

Disadvantages:
1. indirect procedure requiring two visits.
2. Non-esthetic
3. High cost.

b.2) ceramic core (Zirconia core):

Post, core and crown are fabricated as a single component, made out of
glass ceramic material.
Advantages:
1. Good esthetic
2. High mechanical properties: High flexural strength, fracture toughness,
and wear resistance.
3. Biocompatibility.
 Disadvantages:
1. Zirconia is an opaque ceramic… reducing the esthetic appearance of the
restoration
2. brittle materials.

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3. Posterior placement needs to be done with caution, because the mechanical
strength of that region is not enough to withstand the excessive load.
4. High cost.

(Monolithic zirconia): adv:

 natural translucency
 high strength… suitable for the fabrication of full coverage crowns and
bridges
IPS impress heat pressed ceramic core (Cosmopost, Cerapost):

 It is a ready made zirconia post, supplied with ceramic blocks for

core retention.
 It is characterized by its high translucency, and high strength.

Role of core in distribution of stresses

in root canal treated teeth:
Factors affecting role of core in distribution of stresses in root
canal treated teeth:
1) Material of the core:
a) Modulus of elasticity of the core material:
 the modulus of elasticity of the core material should be similar to that of
the post and dentin… amore uniform stress distribution… less risk of
root fracture.
 Large difference in modulus of elasticity of the post, the core and
dentin… stress concentration at the dentin shoulder and apical portion of
the root… increased risk of root fracture.
1. Resin composite core: has a modulus of elasticity close to that of tooth
structure, and leads to most uniform & even distribution of stresses
along tooth structure.
2. cast post and core stresses are concentrated at the cervical portion at
the interface between core &tooth structure

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 b) Adhesion to tooth structure:

 bonded restoration as a core material… more even stress distribution

 bonding integrity to the cervical area plays a critical role in the survival of
the restored tooth
 Composite core + fiber post bind to tooth structure forming a
“Monoblock”… (tooth+post+core) act as one unit… even stress
distribution… less risk of tooth fracture and restoration failure… higher
success rate.

2) Ferrule length/ height:

 Def: circumferential ring (minimum of 1.5-2mm) of sound tooth structure
enveloped by the cervical portion of the crown
 Function (increasing the ferrule height):
1. increased resistance to lateral forces.
2. increased retention
3. dissipate occlusal forces to increase resistance to root fracture.
4. less stress concentration at the cervical portion… less risk of restoration
failure

Conclusion:
Composite resin is an excellent built-up material for anterior and posterior
teeth, in terms of bonding to tooth structure, best stress distribution and
excellent esthetics.

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The ideal relation between post head - core and the
extra coronal restoration

1-THE IMPORTANCE OF THE REMAINING TOOTH

STRUCTURE (FERRULE)

The different relations between the ferrule (remaing tooth structure) and
the post head as follows:

a) Moderate loss of tooth tissue… the post and core provide no

protection… ferrule is provided by the crown.
b) Moderate loss of tooth tissue… beveling of the residual tooth tissue…
the core + the crown provide ferrules.
c) Decoronated, root-treated anterior tooth which is vulnerable to fracture
and requires protection.
d) No protective ferrule provided by the core, or by the crown;
e) No protection provided by the core… only the crown provides a
protective ferrule.
f) Protective ferrule provided by a cast post and diaphragm.
Ideal ferrule length: 2mm
2-Post head shape and the core material

Post head shape is important for core retention.

Serrated post head of Access Post and Flexi-Post: better core retention than
Cerapost

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3-Diferent materials of post and core:

 The ideal post and core material should have

1. physical properties (modulus of elasticity and coefficient of thermal
expansion) similar to dentin.
2. Non-corrosive
3. bonding to dentin.
4. adequate compressive strength to resist intraoral forces
5. sufficient flexural strength
6. biocompatibility,
7. resistance to leakage of oral fluids
8. ease of manipulation,
9. dimensional stability
10.minimal potential for water absorption
11.inhibition of dental caries.

4-Coronal micro leakage and core material

Resin-based composite core may result in microleakage due to:
1. polymerization shrinkage,
2. water adsorption
3. incorporation of voids in the buildup because it cannot be condensed
like amalgam
4. incompatibility with ZOE sealers… incomplete cured resin.
Microleakage can be reduced by:
1. incremental buildup
2. using a condensable resin-based composite
3. Proper removal of the residual root canal sealer
N.B.
-The ideal ferrule length is 2mm.
-The ideal post head length is 1.5mm.
-The ideal preparation stump (ferrule + post head) is 3.5mm.
-Minimum thickness of the remaining tooth structure (ferrule thickness) at
least 1.5mm.
-The post length below the crown is at least equals the crown length.
-The minimal thickness of the extra coronal restoration is at least 1.5mm.

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The monoblock concept and different interfaces in
the post\core with reference to the root canal sealers
(1ry, 2ry,3ry monoblocks)

Def: single unit

Requirements of the materials for a monoblock to function as a
successfully as a mechanically homogenous unit:
1. Bonding to one another and to the tooth structure
2. Elastic modulus similar to one another and to the tooth structure.
Types:

Primary Monoblocks

no. of interfaces: has only one circumferential interface between the

material and the root canal wall.
Trials of 1ry monoblock:
1. Hydron: (HEMA) containing root filling material
Adv: bonding to dentin
Disad: leakage + low modulous of elasticity…. Can not protect tooth
structure
2. MTA which can be used as root canal sealer and mainly used in
retrogradefilling.
Adv:
1. interaction of the released calcium and hydroxyl ions of MTA with
a phosphate-containing synthetic body fluid results in the formation
of apatite-like interfacial deposits which:
 Fill any interfacial gaps
 improve the frictional resistance of MTA to the root canal walls
 accounts for the superior sealing ability of MTA.
2. High compressive strength.
3. Elastic modulus similar to dentin.

Disad: inability to strengthen the root due to:

1. Lack of bonding to dentin.,
2. low tensile strength

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 Secondary Monoblocks

No. of interfaces: have two circumferential interfaces, one between the

cement and dentin and the other between the cement and the core
material.
Examples of secondary monoblock:
1. Adhesively cemented quartz and glass fiber posts especially
those with highly cross-linked methacrylate resin matrix can
form a tooth–post–core monoblock bec:
a. They have modulus of elasticity similar to dentin... better stress
distribution during functioning.
b. Can bond to methacrylate based resin cements which can bond to
root dentin.

Modulus of elasticity of different cements

 modulus of elasticity close to that of dentin:

1.Panavia F (a heavily filled resin cement) =18.3 GPa
2.zinc phosphate cement = 9.3–13.4 GPa,
 some of the stresses were redistributed to the cement layer… tress
concentrations in the root dentin were lower
 posts cemented with zinc phosphate cements often failed because of:
a. its fragility
b. low bonding potential to the root dentin and the post surfaces 45.
 very low modulus of elasticity:
 Superbond C&B cement =1.8 GPa
 glass-ionomer cement =4.0 GPa

deformation of the resin cement was greater… stress concentrations within

the cement layers were low… stresses were directly transferred to the root
dentin

2. Root canal obturation:

a. Gutta percha with an adhesive sealer: glass-ionomer based sealers
bond to root dentin but cannot be used to prevent root fracture in gutta-
percha–filled root canals bec:
1. they do not bond to gutta-percha.
2. modulus of elasticity of gutta-percha points much lower than that of
dentin… not stiff enough to reinforce roots

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b. bondable root canal filling: Resilon:
 applied using a methacrylate-based sealer (epiphany sealer-a
polymerizing sealer) to self-etching primer (epiphany primer) treated
root dentin
 adv: good apical and coronal seal + good fracture resistance but may
not be better than gutta percha and resin sealers
 disad:
1. modulus of elasticity much lower than dentin… does not reinforce
roots
2. The possibility for not achieving perfect seals is due to:
1. extremely high C-factor in root canals (> 1000)… large
polymerization stresses during sealer polymerization… debonding
and gap formation
2. it is a fully polymerized material lacking free radicles for bonding to
methacrylate based sealers.

Tertiary monoblocks
No. of interfaces: a third circumferential interface is introduced between
the bonding substrate and the material,

Examples:

1. Fiber posts that contain an external silicate coating (DT Light SL)
2. Anatomic Post: fiber post that contain unpolymerized resin composite
for relining root canals to conform better to wide, oval canals.
Adv: reduced resin cement layer thickness… less volumetric shrinkage
Disad: gaps were found between the fiber post and the relining
composite… act as stress raisers… adhesive failure… dislodging of
fiber post from the relining composite.

3. Bondable root canal filling materials:

a. EndoRez system:

Composition: gutta peercha coated with resin + hydrophilic sealer to

penetrate into the dentinal tubules for sealing

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Disad: may not act as a mechanically homogenous unit with the root canal
because the bulk of the material inside the root canal still consists of
thermoplastic gutta-percha, an elastomeric polymer that flows when
stressed

b. ActiV GP:

Composition: gutta-percha coated with glass-ionomer fillers.

Adv: glass-ionomer filler coating allows it to be bonded to the root dentin

via a glass-ionomer sealer

Disadv:

1. coronal leakage was found comparable with GP with AH sealer due

to single cone technique with increased volume of GI sealer
2. did not improve the fracture resistance of endodontically treated
teeth.
Conclusion
the concept of creating mechanically homogenous units with root dentin
(monoblocks) is excellent in theory but accomplishing these ideal
monoblocks in the root canal space is not that easy to be done. Due to:

1-Amount of forces falling (tensile and shear stresses) on the brittle tooth
structure after endodontic treatment is greater than the bonding strength of
the adhesive systems.

2- Polymerization shrinkage during curing.

3-Entrapment of residual water within the root canal may act as stress raiser
along the junction between post, sealer and bounded surface, and enhance
crack propagation during specimen testing.

4-All the components of the monoblock don’t have the same modulus of
elasticity of the dentin thus a main factor is not achieved due to
heterogeneity in this complex.

5-adhesive failure between post and cement sealer specially in the tertiary
monoblock

6-The sealing of the monoblock technique can be interrupted along the root
canal length due to difference in its topography.
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 Choice of Luting Cement As Indicated By Post Type

Adhesive VS Non-Adhesive in Metallic Post Cementation

 Ideal requirements of luting cements:

 Compatibility to the tooth and tissue,

 Sufficient working time,
 Flowability,
 Compressive strength
 Minimal microleakage,
 Low solubility in oral fluids,
 Adhesiveness,
 Esthetics,
 Low cost,
 Ease of excess removal

no currently available material satisfies all the ideal requisites and the
material selection should be based on the clinician’s expertise and patient
requirements.(Lad et al. 2014)

 classification:

Conventional cements:
1. Zn phosphate
2. Zn polycarboxyate
3. Glass ionomer
Contemporary cements:
1. Resin modified glass ionomer
2. Adhesive resin

Zn phosphate:
Adv:
1. good working time
2. Rigidity
3. High early strength
Disadv:
1. No bonding to tooth structure
2. Solubility
3. Brittle (low tensile strength)

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Used with:
1. Cast metal post
2. Titanium post

Zn polycarboxylate:
Advantages:

1. Adhesion to tooth structure

Disadvantages:

1. Not resistant to acid dissolution

2. low modulus of elasticity
3. Brittle (low tensile strength)

glass ionomer:

Adv:

1. Chemical bonding to tooth structure

2. Elastic modulus similar to dentin
3. Fluoride release

Disadv:

1. Low mechanical properties

2. High solubility

Resin modified glass ionomer:

Adv:

1. Chemical bonding to tooth structure

2. Elastic modulus similar to dentin
3. Fluoride release
4. Higher strength than CGI
5. Lower solubility than CGI

Disadv: due to the presence of HEMA

1. Increased water sorption… hygroscopic expansion…

Contraindicating their use for posts

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 Adhesive resin cements:

Classification acc to curing:

1. Light cured:
2. Dual cured:
 more uniform resin tag formation
 better diffusion into the dentine than the light-cured variety.
Classification acc to the no. of steps:
1. one-step systems: easy aplication e.g. Rely X
2. two-step: e.g. Panavia F
3. three-step “total etch”: e.g Rely X Arc
o involve:
 acid etching using a Microbrush… thorough rinsing and drying
 application of the dentine bonding agent with a Microbrush
 cementation with a dual or chemically cured luting cement

o adv: create a wider micromechanical interlocking between adhesive

materials and etched dentine
o favoured cementation technique for fiber-based posts
advantages of adhesive cements over conventional ones:
1. increased fracture resistance of the tooth (tooth reinforcement) due
to monoblock formation with better stress distribution.
2. increased post retention.

N.B.:
 The push-out bond strength of quartz fiber posts was significantly
higher in self-adhesive cements compared to total-etch systems and
RelyX Unicem revealed the highest value among all the cements.
 bond strength to the coronal region was higher in total-etch systems
than self-adhesive ones BEC:
Phosphoric acid etching is more effective in highly tubular areas of
the coronal root dentin AS it removes the thick surfaces smear layer
and the smear plug in dentinal tubules formed during post space
preparation to allow more effective micromechanical retention of
resin cements.

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 Bonding of zirconia posts
For mechanical bonding
1. acid etching with hydrofluoric or phosphoric acid:
does not sufficiently roughen the surface for micromechanical
retention
2. surface grinding: to roughen the zirconia surface for mechanical
retention using:
a. abrasive paper or wheels (Al2O3)
b. particle air abrasion (sandblasting) (e.g. Al2O3)
c. diamond bur grinding
disadv:
1. no significant effect on increasing the bond strength of zirconia to
resin cement.
2. Induce surface microcracks… act as crack initiation sites.
For chemical bonding: “sialinization”
 Silane coupling agent: has 2 ends; one organic for polymerization
with the organic matrix of the resin cement, one end that can react
with the silica of porcelain.
 Zirconia lack the silica… sialinization alone is ineffective…
 Sandblasting with Al2O3 followed by Tribochemical silica
coating then Silane treatement increases the bond between
resin cements and zirconia by both chemical and mechanical
means.
 Methods of Tribochemical silica coating:
1. Air abrasion with silica coated alumina particles (CoJet,
Rocatec systems)
2. Silicoating: pyrolytically applying silica coating to the surface
3. Plasma spraying
4. Vapour phase deposition

Choice of the luting cement acc to post material:

1. Metallic posts:
 Zn phosphate cement for easy retrieval
 Adhesive resin cement should not be used as routine with
metallic posts specially parallel-sided posts due to very difficult
retrieval…. High risk of root fracture
2. Non-metallic posts:
a. Fiber posts:
 Adhesive cements are the cements of choice due to easy
irretrievability of fiber posts by drilling through the post with special
reamers.
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 b. zirconia posts:
 Adhesive cements (e.g. panavia F) are the cements of choice due to
higher bonding to both the zirconia surface and dentin when compared
to conventional cements (e.g. glass ionomer)

Success of Post/Core System

The most common failure of endodontically treated teeth is root fracture.

To prevent root fractures, a post should have an elastic modulus similar to
that of dentin —a property which enables a more uniform distribution of
stress by distributing the occlusal load

Survival rate of teeth restored with posts

 Metal posts (prefab Vs cast):
Prefabricated titanium posts showed a slightly higher survival rate:
84.6% versus 82.6% for cobalt-chrome cast post-cores with no
significant difference after 10 y follow up.
 Fiber Vs metal:
 A systematic review 2014 showed no difference in the incidence of
root fracture between metal and fiber post with a higher incidence of
non-catastrophic fractures for fiber-posts.
 An RCT 2014 showed similar survival rate for glass fiber and cast
metal post in teeth with no remaining coronal walls after 3 yrs
 Fiber Vs zirconia:
 Fiber posts have higher restoring success than zirconia due to
favorable failure modes that can be restored.
 Fiber posts showed favourable (restorable) fracture patterns (70%)
 Zirconia posts showed Multiple cracks within the root body (90%
non-restorable).
 Type of tooth:
 maxillary premolars had the highest failure rate (30%) and lowest
mean lifetime (6.5 ys)
 Maxillary incisors showed the highest success rate
 most common mode of failure for adhesively cemented fiber posts
is debonding (adhesive failure) due to adhesive technique
problems

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 Fracture resistance of teeth restored with different post systems
 fiber Vs cast metal posts:
a meta-analysis of literature 2013 concluded that cast post and core has
higher fracture resistance than fiber posts
 glass fiber post and composite resin cores Vs customized zirconia
posts, Vs cast metal post and cores
1. all performed favorably under compressive testing
2. The load required to fracture the zirconia custom post was higher
compared to the fiber post and cast post and core.
3. The fiber post resisted a load higher than the cast post and core.
 Fiber Vs zirconia:
 post length is a more critical factor in teeth restored with one-piece
milled zirconia posts than in those restored with fiber posts
 zirconia posts had higher fracture resistance than fiber posts.

Crown Systems Related To Endodontic Materials (Sealers

and Irrigation) On Post Bonding
debonding has been stated as the primary cause of failure in fiber posts.
Studies have reported that endodontic materials, like sealers (Soares et al.
2012) and irrigants, may affect the long term success of bonding and bond
strength of fiber posts to root dentin.

Sealers:
1. Eugenol based sealers(e.g. Endofill)
Reduce the bond strength of composite resin core build-up and of
adhesively cemented fiber posts bec: Eugenol inhibits the polymerization
of resin cements… should not be used when adhesively cemented fiber
posts are to be placed
2. Epoxy-resin based sealers (e.g. AH-Plus)
 the preferred endodontic sealer nowadays due to:
1. satisfactory physical properties
2. acceptable biological performance
3. smaller number of gap-containing interface areas
4. higher adhesiveness to root dentin.
 AH-Plus promoted higher bond strength values between the FRC and
root dentin than did salicylate resin- and eugenol-based sealers after 15
days… the recommended sealer with fiber posts.

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Irrigants
1. NaOCl

 The most commomnly used irrigant due to:

1. Antibacterial effect
2. Organic tissue dissolving ability.
 Effect on bonding:
Reduces the bond strength of adhesively cemented glass fiber posts
bec… it breaks down the carbon-atom bonds causing collagen
degradation.
2.EDTA
 A chelating agent: Used as an irrigant for
1. removal of the inorganic component smear layer formed during
post space prep
2. decalcification of inter-tubular and peritubular dentin
 this helps:
1. improve the action of chemical substances on dentin
2. closer contact of the filling material with the root dentine
3. combinig NaOCl and EDTA

increase bond strength of fiberglass posts cemented with self-adhesive

resin cement to intraradicular dentine.
4. CHX
The preferred irrigant when bonding to root dentin is required
It does not interfere with the bond strength of adhesively cemented fiber
posts bec.:
1. It does not interfere with the collagen present in the organic matrix of
root dentin
2. inhibiting matrix metalloproteinase in the hybrid layer, which are
collagen-degrading enzymes… improving the longevity of the
composite adhesive bonded to dentin

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