Dental Materials Journal 2008; 27(4): 605611 Original Paper

Stress Distribution in Roots Restored with Different Types of Post Systems with Composite Resin
Daizo OKADA, Hiroyuki MIURA, Chikako SUZUKI, Wataru KOMADA, Chiharu SHIN, Masahiro YAMAMOTO and David MASUOKA
Fixed Prosthodontics, Department of Restorative Science, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan Corresponding author, Daizo OKADA; E-mail: d.okada.fpro@tmd.ac.jp

Although composite resin core is used with various types of prefabricated posts, it remains unclear which kind of material is most suitable for the post. The aim of this study was to evaluate the inuence of prefabricated posts on the stress distribution within the root by finite element analysis. Posts and cores were built up with composite resin and four types of prefabricated posts: two types of glass fiber posts (GFP1, GFP2) with low and high Youngs moduli, a titanium post (TIP), and a stainless steel post (SSP). In all models, stress distribution during function was calculated. There were differences in stress concentration at the root around the end of posts. The magnitudes of stress for GFP1, GFP2, TIP, and STP were 8.7, 9.3, 11.7, and 13.9 MPa respectively. Given the results obtained, GFP1 was the most suitable material for post fabrication since this model showed a lower stress value. It would therefore mean a lower possibility of root fracture. Key words: Nonlinear finite element analysis, Youngs modulus, Von Mises stress Received Feb 5, 2008: Accepted Mar 13, 2008

INTRODUCTION Posts and cores are frequently used to restore endodontically treated teeth, prior to the final restoration. Traditionally, cast post and core systems are the preferred choice because of their superior mechanical strength1-3). However, owing to a large difference in Youngs modulus between metal and dentin, an excessive concentration of functional stresses may occur around the end of the post, resulting in catastrophic vertical root fracture2,5,6). When the latter occurs, re-restoration is difficult in most cases, leading to the extraction of teeth4). Recently, composite resins have been used as core build-up materials after endodontic treatment instead of cast posts and cores. By virtue of a Youngs modulus that is similar to that of dentin5,6), use of composite resin cores aids to reduce stress concentration within the roots of endodontically treated teeth and hence prevent catastrophic vertical root fracture. It should also be mentioned that composite resins can be used as core build-up materials because of remarkable improvement in the mechanical properties of composite resins7). On the other hand, it has been suggested in many researches that composite resin cores with prefabricated posts have significantly lower fracture strength than cast posts and cores1,7-9). Nonetheless, composite resin cores weld several upper-hand advantages over cast post and core systems. For example, with composite resin cores, there is reduced risk of unrepairable root fracture (versus catastrophic

vertical root fracture caused by cast posts and cores) and reduced leaching of corroded metal ions (which may trigger an allergic reaction)10). On esthetic appeal, composite resin cores are able to reproduce the shade and translucency of natural teeth when all-ceramic crowns or polymer-based restorative material crowns are chosen as the final restoration11,12). Against this backdrop of laudable functional and esthetic advantages, use of composite resin cores combined with various kinds of prefabricated metal and non-metal posts is gaining in popularity and on the rise such as glass fiber post5,8,11), quartz fiber post5), stainless steel post5,13), titanium post13), and carbon fiber post14). However, in this wide gamut of prefabricated post systems, there belies a large difference in Youngs modulus among the various kinds of post materials and this difference may inuence the magnitude and distribution of stress within the root. To date, it remains unclear which kind of post material is most suitable for combined use with composite resin cores. Finite element analysis is one of the commercially available methods to investigate stress distributions within the root. Most researches applied normalized force to finite element models, although the directions of occlusal force are complex in vivo. The aim of this study, therefore, was to evaluate the inuence of various types of prefabricated posts during function on stress distribution in an abutment tooth restored with composite resin. This was achieved by subjecting in vivo

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Dent Mater J 2008; 27(4): 605611 no symptoms of stomatognathic disorder. The sensor was fixed to the subject tooth with a temporary cement, so that no excessive stress was concentrated on the lower surface of the sensor. Thus, this sensor was noninvasive on the subject tooth. Sufficient explanation about this study was given to the subject and informed consent was obtained prior to this study. Test food was a 55 mm piece of beef jerky (Beef Steak Jerky, Suzusho Ltd., Tokyo, Japan). The occlusal force exerted while masticating beef jerky was measured with this small sensor. Finite element model Previous finite element analyses7,18-20) were performed on the basis of linear analysis, although the periodontal ligament had viscoelastic properties21,22). This viscoelastic characteristic might have a great

measurements to three-dimensional finite element analysis. MATERIALS AND METHODS Three-dimensional occlusal force To investigate occlusal force in vivo, a small handmade three-dimensional occlusal force sensor was applied to an endodontically treated tooth (Fig. 1), as previously described15-17). This sensor consisted of two-tiered parallel plates to which eight strain gages were attached to detect the three-dimensional occlusal force (corono-apical, mesio-distal, and buccopalatal occlusal force). This sensor was so small that measurements could be taken in the dowel space for cast post and core. Subject tooth employed was the maxillary left first molar of a 30-year-old Japanese male who had

Fig. 1 Table 1

The small three-dimensional occlusal force sensor.

Mechanical properties of materials Youngs modulus (MPa) Dentin

23) 21)

Poissons ratio 0.31 Nonlinear elastic 0.30 0.31 0.30 0.45 0.33 0.30 0.30 0.30 0.30 0.33 0.40

15000 Nonlinear elastic 13700

23)

Periodontal ligament Lamina dura24) Cancellous bone Cortical bone24) Gutta-percha

25)

345 13700 0.69

26)

Composite resin cores Stainless steel Titanium Glass fiber post (I)8) Glass fiber post (II)

12000 200000 110000 29200 45000 86000 4500

Gold-silver-palladium alloy27) Luting agent

28)

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Fig. 2

Finite element analysis models. MC: full cast crown model; MMA: methyl methacrylate-based resin cement.

Fig. 3

Material property of periodontal ligament21).

inuence on the stress distribution within the root. Therefore, nonlinear analysis was performed in this study. Four types of three-dimensional nonlinear finite element models were developed and analyzed using a finite element analysis software (MSC Marc Mentat 2003, MSC Software Corp., Santa Ana, CA, USA). In all the models, it was assumed that the subject tooth underwent endodontic treatment, and that fabricated posts and cores with four types of prefabricated post materials and composite resin core were used. It was also assumed that gold-silver-palladium alloy crown was cemented (Fig. 2). All models consisted of a crown, luting agent, composite resin core, prefabricated post, dentin, gutta-percha, periodontal ligament, lamina dura, cancellous bone, and cortical bone. The restored tooth was 18 mm in height with a diameter of 6 mm at the level of the crown margin. The apical 12 mm of the root was modeled by investing it in a socket of lamina dura 0.3 mm thick and had a uniform periodontal ligament thickness of 0.2 mm. In each model, dowel space was 8 mm in depth and the heights of core and crown were 4 mm and 6 mm respectively (Fig. 2). Four types of prefabricated post materials were included in this study, namely, stainless steel post (SSP), titanium post (TIP), and two types of glass fiber posts (GFP1, GFP2). In all models, each element was assigned a unique elastic property to represent the modeled material (Table 1)8,21,23-28). Except for the periodontal ligament, homogeneity, isotropy, and linear elasticity were assumed for all materials, including continuous interfaces between materials. A nonlinear elastic property was assigned

to the periodontal ligament because it has viscoelastic properties (Fig. 3)21,22). The occlusal force exerted while masticating beef jerky, which was measured with the threedimensional occlusal force sensor, was applied to a node located at the center of the occlusal surface. Stress produced in the dentin of each root was calculated as von Mises stress, and stress distribution in the root was analyzed. The magnitudes of von Mises stress at the nodes of the cervical surface, end of the post, and root apex were compared among the four types of prefabricated models. RESULTS Three-dimensional occlusal force The occlusal force exerted while masticating beef jerky was measured in vivo with the small threedimensional occlusal force sensor consisting of parallel plates and strain gages15-17). Direction of the occlusal force during the mastication of beef jerky was in the disto-palato-apical direction, and the magnitudes in the palatal, distal, and apical directions are shown in Table 2. Finite element analysis Figure 4 shows the von Mises stress distributions within the root which was restored with composite resin core and four types of prefabricated post materials while masticating beef jerky. GFP1 and GFP2 dispersed the stress along the post within the root, when compared to SSP and TIP. Table 3 shows the magnitudes of von Mises stress in the cervical area, at the end of the post, and at the apex of the root. In the cervical area of the

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Table 2

Dent Mater J 2008; 27(4): 605611

Direction of the occlusal force during mastication of beef jerky (N) Mesio-distal direction 28.9 Apico-coronal direction 164.3 Table 3 Magnitude of von Mises stresses at each point of analysis by finite element analysis (MPa) SSP Cervical area End of post Apex area 21.5 13.9 14.4 TIP 22.1 11.7 14.1 GFP1 23.0 8.7 13.7 GFP2 22.8 9.3 13.8

Bucco-palatal direction 23.9

Abbreviations as in Fig. 4

Fig. 4

Comparison of von Mises stress distributions in the root in frontal plane (MMA).

dentin and at the apex of the root, there seemed to be no differences among the four types of prefabricated post materials. On the contrary, in the dentin of the root around the end of the prefabricated posts, there were differences in stress concentration. The magnitudes of stress in this area for SSP, TIP, GFP1, and GFP2 were 13.9 MPa, 11.7 MPa, 8.7 MPa, and 9.3 MPa respectively. DISCUSSION Occlusal force Occasionally, an excessive occlusal force leads to root fracture8,29,30), especially in endodontically treated teeth. Therefore, it is very important to evaluate in detail the force applied to each tooth in function. Measurements of masticatory force have been performed by numerous researchers, amongst whom were Scott et al.31) and McCall et al.32). However, sufficient three-dimensional data have not been

acquired, as actual measurements in function are difficult to make, or that experimental methods could not warrant vector analysis31,32). The force loaded horizontally to a tooth is commonly known as the lateral occlusal force, and undisputedly recognized as harmful to the periodontal tissues due to the organization of periodontal ligament fibers. Therefore, it is very important to make a three-dimensional analysis of the occlusal force and apply these results to other researches. Measurements of the occlusal force have been attempted in different ways. For example, electromyogram or detection of crown distortion with strain gages33,34) have been used to estimate the occlusal force. At this juncture, it must be clarified that these data were essentially different from actual occlusal forces or that they could detect only the direction of the occlusal force. In this study, it is shown that both magnitude and direction of threedimensional occlusal force in function could be

Dent Mater J 2008; 27(4): 605611 detected in a chronological order without changing the vertical dimension and occlusal contacts. Therefore, the herein-used occlusal force sensor was very useful for estimating occlusal forces. One of the most important factors that inuences root fracture is parafunctional occlusal force. This kind of occlusal force is excessive and continuous, and which cannot be measured precisely because it usually cannot be reproduced. Therefore, threedimensional occlusal force during mastication was applied instead of parafunctional occlusal force. Finite element model In this study, a simple premolar model was used. This is because the complex shapes of crown, root, or post and core may inuence stress distribution. However, prior to considering the complex shapes of crown, root, or post and core, the inuence of material properties on stress distribution within the root should be investigated. Therefore, a simple premolar model was used in this study. Many finite element analyses were performed using linear elastic models7,18), although the periodontal ligament has a viscoelastic characteristic21,22). Differences between linear and nonlinear analyses may inuence the results of finite element analyses. Stress distribution of nonlinear finite analysis may resemble more of that in endodontically treated teeth in vivo than that of linear finite analysis. In the former analysis, the material properties of the periodontal ligament were assumed to have nonlinear elasticity. In the present study, the approximate function for the periodontal ligament was adapted from a previous research21). In addition to material properties, the number of elements forming the periodontal ligament also greatly inuenced stress distribution within the root. During function, the amount of distortion of the periodontal ligament was larger compared to other components. Therefore, care had to be exercised during the construction of the periodontal ligament. Indeed, one important consideration in the construction of a finite element model is the number of elements, especially for components which are expected to exhibit large deformation. If material properties and shape of the finite element model were in proper order, a larger number of elements will lead to more precise finite element analysis results. However, a larger number of elements will require a longer computational time on a personal computer. Therefore, an appropriate number of elements is necessary for finite element analysis. The structure of the periodontal ligament also has a great inuence on stress distribution. In this study, prior to constructing the periodontal ligament model, the number of layers of the periodontal ligament was investigated. The degrees of distortion

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of varied numbers of layers of the periodontal ligament of the finite element model were compared with previous studies that entailed in vivo measurements. One or two layers only would render a periodontal ligament that was too stiff compared with these studies. On the other hand, three layers and more would lead to results in agreement with these studies. Therefore, the number of layers of the periodontal ligament was determined as three. Four types of prefabricated post materials were included in this study namely, stainless steel post, titanium post, and two types of glass fiber posts (GFP1, GFP2). The latter two types of glass fiber posts were included because remarkably improved glass fiber posts have been recently developed and are commercially available as prefabricated glass fiber posts. In this study, the Youngs moduli of two types of glass fiber posts were 29.2 MPa and 45.0 MPa. Distribution and magnitude of stress Undoubtedly, root fracture is one undesirable incident to both patients and dentists alike. The probability of root fracture in endodontically treated teeth is higher than that of vital teeth. One cause to the root fracture of endodontically treated teeth is stress concentration around the end of the post8,29,30). For composite resin cores with prefabricated posts, a frequently occurring fracture mode is the horizontal root fracture which is repairable. For cast posts and cores, it is vertical root fracture which then leads to the extraction of teeth8). To prevent catastrophic vertical root fracture, it is necessary to investigate stress distribution within the root, including that around the end of the post in various kinds of post materials. To date, there is no consensus on which is the most suitable post material for combined use with composite resin core during function. In this study, the magnitudes of von Mises stress of four types of post materials with composite resin core during function were calculated. In the cervical area and at the apex of the root, there were no differences in the magnitude of von Mises stress among the four types of post materials. In this study, there were no differences in marginal shape and depth among the models. However, these factors or ferule effect may inuence the distribution of stress around the cervical area of the root35). In addition, the crown material or luting agent may also inuence the distribution of stress around the cervical area17). In the same vein, it has been reported that the level of alveolar bone affected the magnitude of fracture strength of various kinds of posts and cores8). Therefore, more research efforts will need to be devoted to investigating the distribution of stress around the cervical area. In sharp contrast, at the end of the post, there

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Dent Mater J 2008; 27(4): 605611 von Mises stress at the cervical area and apex of the root. Glass fiber post with the lower Youngs modulus exhibited the lowest stress concentration in the root around the end of the post, thereby indicating a lower possibility of root fracture. Magnitude of stress in the cervical area was higher than that at the root apex and around the end of the post. ACKNOWLEDGEMENTS This study was supported in part by a Grant-in-aid for Scientific Research from the Japanese Society for the Promotion of Science (Nos. 19209059, 18791425). REFERENCES
1) Martinez-Insua A, da Silva L, Rilo B, Santana U. Comparison of the fracture resistances of pulpless teeth restored with a cast post and core or carbonfiber post with a composite core. J Prosthet Dent 1998; 80: 527-532. Fraga RC, Chaves BT, Mello GS, Siqueira JF Jr. Fracture resistance of endodontically treated roots after restoration. J Oral Rehabil 1998; 25: 809-813. Holmes DC, Diaz-Arnold AM, Leary JM. Inuence of post dimension on stress distribution in dentin. J Prosthet Dent 1996; 75: 140-147. Goto Y, Nicholls JI, Phillips KM, Junge T. Fatigue resistance of endodontically treated teeth restored with three dowel-and-core systems. J Prosthet Dent 2005; 93: 45-50. Akkayan B, Glmez T. Resistance to fracture of endodontically treated teeth restored with different post systems. J Prosthet Dent 2002; 87: 431-437. Newman MP, Yaman P, Dennison J, Rafter M, Billy E. Fracture resistance of endodontically treated teeth restored with composite posts. J Prosthet Dent 2003; 89: 360-367. Pegoretti A, Fambri L, Zappini G, Bianchetti M. Finite element analysis of a glass fiber reinforced composite endodontic post. Biomaterials 2002; 23: 2667-2682. Komada W, Miura H, Okada D, Yoshida K. Study on the fracture strength of root reconstructed with post and core: alveolar bone resorbed case. Dent Mater J 2006; 25: 177-182. Asmussen E, Peutzfeldt A, Heitmann T. Stiffness, elastic limit, and strength of newer types of endodontic posts. J Dent 1999; 27: 275-278. Schmalz G, Garhammer P. Biological interactions of dental cast alloys with oral tissues. Dent Mater 2002; 18: 396-406. Iglesia-Puig MA, Arellano-Cabornero A. Fiberreinforced post and core adapted to a previous metal ceramic crown. J Prosthet Dent 2004; 91: 191-194. Ikeda M, Nikaido T, Foxton RM, Tagami J. Shear bond strengths of indirect resin composites to hybrid ceramic. Dent Mater J 2005; 24: 238-243.

were apparent differences in stress concentration. For GFP1, the concentration of von Mises stress at the end of the post ranked the lowest at 8.7 MPa. On the other hand, with SSP, the concentration of von Mises stress was the highest at 13.9 MPa. With the two types of glass fiber posts (GFP1, GFP2), they did not exhibit any concentration of stress around the end of the post, when compared with the prefabricated metal posts (SSP, TIP). There is a relationship between Youngs modulus and stress concentration in the root around the end of the post. With a higher Youngs modulus of the prefabricated post, a larger stress was concentrated around the end of the post. As for composite resin cores with glass fiber posts, stress was dispersed along the posts and the whole root, thereby decreasing the possibility of vertical root fracture. On the other hand, in the case of prefabricated metal posts, especially SSP, there was a large stress concentration around the end of the post and at the end of the post in the root. In this study, it was assumed that the different kinds of post materials adhered tightly to the composite resin. However, the adhesive properties might have an effect on the distribution of stress within the root36-41). Within the limitations of this experiment, the glass fiber post, especially GFP1, was found to be the most suitable candidate since this model showed a lower stress value. This also meant reduced possibility of root fracture. Concerning the magnitude of von Mises stress at the cervical area, there were no significant differences among the four types of post materials. However, the magnitude of stress in the cervical area was higher than that around the end of the post. Stress at the cervical area might be related to horizontal root fracture. To prevent horizontal root fracture, it is therefore important to reduce stress concentration at the cervical area of the root. Taking into consideration that there were no differences in the magnitude of von Mises stress at the cervical area among the four types of prefabricated posts, and that occlusal forces and stress might be transmitted via the crown and cement to the cervical area of the root, the material properties of crown and luting agent would affect the magnitude of stress. Therefore, further studies on stress distribution within the root are evidently warranted for different kinds of crown materials and luting agents. CONCLUSIONS Within the limitations of this experiment, the following conclusions were drawn for a composite resin core with four types of prefabricated metal and non-metal posts: 1. There were no differences in the magnitude of

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3.

2) 3) 4)

5) 6)

7)

8)

9) 10) 11) 12)

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