MTA versus CEM root-end fillings effect on fracture resistance of endodontically treated simulated immature teeth restored with cast metal posts: an in-vitro study

Background: Endodontically treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture. An apical plug is usually used as root end filling in order to seal the wide apical foramen. The current study was performed to evaluate the effect of different root-end filling materials (MTA and CEM) on fracture resistance of teeth restored with cast metal posts.Methods: A total of 40 extracted intact single-rooted human mandibular premolars (removed for orthodontic reasons) were used in the study. The coronal part of each tooth was removed and root canal preparation was performed. A size 4 Gates Glidden drill was used to enlarge the canal and was passed through the apical foramen in order to simulate an immature apex. Samples were randomly divided into 5 groups according to apical plug (Group 1: No plug, Group 2: 5 mm MTA plug, Group 3: 5 mm CEM plug, Group 4: 2 mm MTA plug, Group 5: 2 mm CEM plug). Post-space preparations were performed and cast metal post-and-cores were fabricated and cemented. Fracture resistance was assessed using a universal testing machine. Fracture thresholds were recorded and data were analyzed using SPSS 16.0 with significance level at P value < 0.05. Results The analysis showed a significant difference of fracture resistance between groups (p-value<0.05). The mean fracture resistance of samples in group 1 was significantly lower than group 2 (p-value=0.003). there was no significant difference between other groups (p-value>0.05).Conclusions: Within the limits of this study, the evidence indicated that placement of a 5 mm MTA apical plug increased the fracture resistance in simulated immature teeth which are restored with cast metal posts, compared to control group (gutta-percha and sealer). While the results were not as promising for a 2 mm MTA apical plug or either 2 or 5 mm CEM apical plug.

[1]  A. Bacchi,et al.  Restorative preferences and choices of dentists and students for restoring endodontically treated teeth: A systematic review of survey studies. , 2020, The Journal of prosthetic dentistry.

[2]  J. Yoo,et al.  Fracture resistance of teeth obturated with two different types of Mineral Trioxide Aggregate Cements , 2020, Brazilian Dental Science.

[3]  Pawan Darak,et al.  Comparative evaluation of fracture resistance of simulated immature teeth and its effect on single visit apexification versus complete obturation using MTA and biodentine , 2020, Journal of family medicine and primary care.

[4]  P. Dummer,et al.  Fracture Resistance of Immature Incisors Following Root Filling with Various Bioactive Endodontic Cements Using an Experimental Bovine Tooth Model , 2019, European Journal of Dentistry.

[5]  W. McLean,et al.  The use of Bioceramics as root-end filling materials in periradicular surgery: A literature review , 2018, The Saudi dental journal.

[6]  Bijani Ali,et al.  Fracture strength of teeth restored with fiber post and apical plug , 2017 .

[7]  T. Donovan,et al.  Survey of dentists to determine contemporary use of endodontic posts , 2017, The Journal of prosthetic dentistry.

[8]  P. Nagmode,et al.  The Effect of Mineral Trioxide Aggregate on the Periapical Tissues after Unintentional Extrusion beyond the Apical Foramen , 2016, Case reports in dentistry.

[9]  T. Gok,et al.  Fracture resistance of simulated immature teeth after apexification with calcium silicate-based materials , 2016, European journal of dentistry.

[10]  E. Bayram,et al.  Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine , 2016, European journal of dentistry.

[11]  S. Türker,et al.  Evaluation of the Bond Strength and Fracture Resistance of Different Post Systems. , 2015, The journal of contemporary dental practice.

[12]  H. Badrian,et al.  Microhardness Properties of Mineral Trioxide Aggregate and Calcium-enriched Mixture Cement Plugs at Different Setting Conditions , 2015, Journal of international oral health : JIOH.

[13]  S. Sarkar,et al.  A comparative evaluation of ideal apical sealing material for open apex single rooted permanent tooth: An in vitro study , 2015 .

[14]  P. Martins-Filho,et al.  Do metal post-retained restorations result in more root fractures than fiber post-retained restorations? A systematic review and meta-analysis. , 2015, Journal of endodontics.

[15]  F. Ayatollahi,et al.  Sealing Ability of Mineral Trioxide Aggregate and Calcium-Enriched Mixture Cement as Apical Barriers with Different Obturation Techniques , 2014, Iranian endodontic journal.

[16]  K. Ghazvini,et al.  Sealing Ability of Orthograde MTA and CEM Cement in Apically Resected Roots Using Bacterial Leakage Method , 2013, Iranian endodontic journal.

[17]  M. Jafarabadi,et al.  Fracture resistance of immature teeth filled with mineral trioxide aggregate or calcium-enriched mixture cement: An ex vivo study , 2012, Dental research journal.

[18]  N. Naghavi,et al.  Comparison of Endodontic Biomaterials as Apical Barriers in Simulated Open Apices , 2012, ISRN dentistry.

[19]  C. Goracci,et al.  Current perspectives on post systems: a literature review. , 2011, Australian dental journal.

[20]  Wei-rong Tang,et al.  Identifying and reducing risks for potential fractures in endodontically treated teeth. , 2010, Journal of endodontics.

[21]  Konstantinos Chochlidakis,et al.  A systematic review of dowel (post) and core materials and systems. , 2009, Journal of prosthodontics : official journal of the American College of Prosthodontists.

[22]  J. Andreasen,et al.  Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. , 2006, Dental traumatology : official publication of International Association for Dental Traumatology.

[23]  D N J Ricketts,et al.  Post and core systems, refinements to tooth preparation and cementation , 2005, British Dental Journal.

[24]  Richard S Schwartz,et al.  Post placement and restoration of endodontically treated teeth: a literature review. , 2004, Journal of endodontics.

[25]  S M Morgano,et al.  Clinical success of cast metal posts and cores. , 1993, The Journal of prosthetic dentistry.