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      A comparison of the fracture resistances of endodontically treated mandibular premolars restored with endocrowns and glass fiber post-core retained conventional crowns

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          Abstract

          PURPOSE

          This in-vitro study aimed to evaluate the fracture resistances and failure modes of endodontically treated mandibular premolars restored with endocrowns and conventional post-core retained crowns.

          MATERIALS AND METHODS

          Thirty mandibular premolars were assigned into three groups (n=10): GI, intact teeth; GE, teeth with endocrowns; GC, teeth with conventional post-core supported crowns. Except for the teeth in group GI, all specimens were cut to 1.5 mm above the cementoenamel junction and endodontically treated. Both endocrowns and conventional crowns were fabricated from lithium-disilicate blocks using a CEREC 3D CAD/CAM unit. All specimens were subjected to thermocycling and then to 45° oblique compressive load until fracture occurred. The fracture resistance and failure mode of each specimen were recorded. Data were analyzed with one-way ANOVA and LSD Post Hoc Test (α=.05).

          RESULTS

          The fracture resistances of GE and GC were significantly lower than that of GI ( P<.01), while no significant difference was found between GE and GC ( P=.702). As of the failure mode, most of the specimens in GE and GC were unfavorable while a higher occurrence of favorable failure mode was presented in GI.

          CONCLUSION

          For the restoration of mandibular premolar, endocrown shows no advantage in fracture resistance when compared with the conventional method. Both of the two methods cannot rehabilitate endodontically treated teeth with the same fracture resistances that intact mandibular premolars have.

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          Most cited references22

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          Post placement and restoration of endodontically treated teeth: a literature review.

          The restoration of endodontically treated teeth is a topic that is extensively studied and yet remains controversial from many perspectives. This article reviews the major pertinent literature on this topic, with an emphasis on major decision-making elements in post placement and restoration of endodontically treated teeth. Recommendations are made for treatment planning, materials, and clinical practices from restorative and endodontic perspectives.
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            Reduction in tooth stiffness as a result of endodontic and restorative procedures.

            Endodontically treated teeth are thought to be more susceptible to fracture as a result of the loss of tooth vitality and tooth structure. This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids. An encapsulated strain gauge was bonded on enamel just above the cementoenamel junction on both the buccal and lingual surfaces, and the teeth were mounted in nylon rings leaving 2 mm of root surface exposed. Under load control, each tooth was loaded at a rate of 37 N per s for 3 s and unloaded at the same rate in a closed loop servo-hydraulic system to measure stiffness. A stress-strain curve was generated from each gauge prior to alteration of the tooth and after each procedure performed on the tooth. Cuspal stiffness, as a measure of tooth strength, was evaluated on one of two series of sequentially performed procedures: 1. (a) unaltered tooth, (b) access preparation, (c) instrumentation, (d) obturation, and (e) MOD cavity preparation; or 2. (a) unaltered tooth, (b) occlusal cavity preparation, (c) two-surface cavity preparation, (d) MOD cavity preparation, (e) access, (f) instrumentation, and (g) obturation. Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Biomechanical considerations in restoring endodontically treated teeth.

              Various concepts for dental treatment have been established without appropriate documentation, such as restoration of endodontically treated teeth. Some researchers and dentists strongly recommend including a post with the restoration to strengthen the root. Other studies have indicated that posts may substantially weaken the roots and should be avoided. An additional approach suggested that the post did not improve the resistance to fracture during occlusion and did not support the restoration. Biomechanical problems are analyzed, and a recommended clinical approach is presented.
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                Author and article information

                Journal
                J Adv Prosthodont
                J Adv Prosthodont
                JAP
                The Journal of Advanced Prosthodontics
                The Korean Academy of Prosthodontics
                2005-7806
                2005-7814
                December 2016
                15 December 2016
                : 8
                : 6
                : 489-493
                Affiliations
                [1 ]Department of Stomatology, the Chinese PLA General Hospital, Beijing, China.
                [2 ]Department of Mechanical Engineering, University of Science and Technology, Beijing, China.
                [3 ]Department of Stomatology, the People's Hospital of Cangzhou, Hebei, China.
                Author notes
                Corresponding author: Hongbo Li. Department of Stomatology, The Chinese PLA General Hospital, 28th FuXing Road, Beijing 100853, China. Tel. +8613601244428: hongbolli@ 123456sina.com

                This author contributed equally to this work and should be considered co-first author

                Author information
                http://orcid.org/0000-0002-9896-9455
                Article
                10.4047/jap.2016.8.6.489
                5179488
                28018567
                a4e7f77a-739d-4d60-94ae-ed7bb19f867f
                © 2016 The Korean Academy of Prosthodontics

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 May 2016
                : 19 September 2016
                : 28 September 2016
                Funding
                Funded by: Beijing Science and Technology Committee;
                Award ID: 2010B078
                Award ID: Z141100002114031
                Categories
                Original Article

                Dentistry
                endocrown,mandibular premolar,intact tooth,fracture resistance,failure mode
                Dentistry
                endocrown, mandibular premolar, intact tooth, fracture resistance, failure mode

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