Journal of Operative Dentistry & Endodontics

Register      Login

VOLUME 4 , ISSUE 2 ( July-December, 2019 ) > List of Articles

Original Article

Comparative Evaluation of the Fracture Resistance of Simulated Immature Teeth Reinforced with a Novel Anatomic Post and MTA or Biodentine as an Apical Barrier: An In Vitro Study

Shivani H Dholakia, Mrunalini J Vaidya

Keywords : Apexification, everStick post, Immature teeth, Reinforcement,Anatomic post

Citation Information : Dholakia SH, Vaidya MJ. Comparative Evaluation of the Fracture Resistance of Simulated Immature Teeth Reinforced with a Novel Anatomic Post and MTA or Biodentine as an Apical Barrier: An In Vitro Study. J Oper Dent Endod 2019; 4 (2):62-67.

DOI: 10.5005/jp-journals-10047-0081

License: CC BY-NC 4.0

Published Online: 21-07-2020

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: To evaluate and compare the resistance to fracture of simulated human immature teeth treated with MTA/Biodentine as apical barrier, reinforced with a novel anatomic post. Materials and methods: Eighty extracted maxillary central incisors were used in this study. Access opening was done, and ProTaper rotary instruments up to F3 were used to prepare the root canal. Peeso reamers were used sequentially up to size 6 (1.7 mm) with 1 mm beyond the apex to simulate immature teeth. Irrigation with 2.5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) was done. They were then divided into two groups (n = 40 each) according to the apical barrier used for apexification: group I—apical barrier using Biodentine and group II—apical barrier using MTA. Each group was then divided into four subgroups: subgroup A (n = 10)—apical barrier using Biodentine/MTA with no obturation, subgroup B (n = 10)—apical barrier using Biodentine/MTA with everStick post as reinforcement, subgroup C (n = 10)—apical barrier using Biodentine/MTA with complete filling using the same material used for apical barrier, and subgroup D (n = 10)—apical barrier using Biodentine/MTA with prefabricated glass fiber post as reinforcement. All samples were incubated for two weeks at 37°C before subjecting to fracture testing using the Universal Testing Machine. A compressive load was applied at 135° to the long axis of the tooth. Results: Statistical analysis was done using one-way ANOVA test and post hoc Bonferroni test. In the above tests, p value less than 0.05 (p < 0.05) was taken to be statistically significant. Conclusion: A novel anatomic post, everStick post is a viable option for reinforcement of teeth with immature root apex and thin dentinal walls after apexification.

PDF Share
  1. Wilkinson KL, Beeson TJ, Kirkpatrick TC. Fracture resistance of simulated immature teeth filled with resilon, guttapercha, or composite. J Endod 2007;33(4):480–483. DOI: 10.1016/j.joen.2006.11.014.
  2. Cauwels RGE, Pieters IY, Martens LC, et al. Fracture resistance and reinforcement of immature roots with gutta percha, mineral trioxide aggregate and calcium phosphate bone cement: a standardized in vitro model. Dental Traumatolog 2010;26(2):137–142. DOI: 10.1111/j.1600-9657.2010.00869.x.
  3. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992;8(2):45–55. DOI: 10.1111/j.1600-9657.1992.tb00228.x.
  4. Topçuoğlu HS, Kesim B, Düzgün S, et al. The effect of various backfilling techniques on the fracture resistance of simulated immature teeth performed apical plug with Biodentine. Int J Paediate Dent 2015;25(4):248–254. DOI: 10.1111/ipd.12137.
  5. Desai S, Chandler N. The restoration of permanent immature anterior teeth, root filled using MTA: a review. J Dent 2009;37(9):652–657. DOI: 10.1016/j.jdent.2009.05.026.
  6. Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod 2017;43(2):238–245. DOI: 10.1016/j.joen.2016.10.030.
  7. American Association of Endodontists. Restoration of endodontically treated teeth: the endodontist's perspective part 1. Available at:,-the endodontist-s-perspective-part-1.aspx. Accessed November 7, 2017.
  8. Schmoldt SJ, Kirkpatrick TC, Rutledg RE, et al. Reinforcement of simulated immature roots restored with composite resin, mineral trioxide aggregate, guttapercha, or a fiber post after thermocycling. J Endod 2011;37(10):1390–1393. DOI: 10.1016/j.joen.2011.07.001.
  9. Lawley GR, Schindler WG, Walker 3rd WA, et al. Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification. J Endod 2004;30(3): 167–172. DOI: 10.1097/00004770-200403000-00010.
  10. Park JB, Lee JH. Use of mineral trioxide aggregate in the open apex of a maxillary first premolar. J Oral Sci 2008;50(3):355–358. DOI: 10.2334/josnusd.50.355.
  11. Sirimai S, Riis DN, Morgano SM. An in vitro study of the fracture resistance and the incidence of vertical root fracture of pulpless teeth restored with post-and-core systems. J Prosthet Dent 1999;81(3): 262–269. DOI: 10.1016/S0022-3913(99)70267-2.
  12. Anil P, Aparna A. Esthetic rehabilitation of a crown fracture with glass-fibre-reinforced posts: a case report. Int J Sci Res Publ 2012;2: 2250–3153.
  13. Kim JH, Park SH, Park JW, et al. Influence of post types and sizes on fracture resistance in the immature tooth model. J Korean Acad Conserv Dent 2010;35:257–267. DOI: 10.5395/JKACD.2010.35.4.257.
  14. Makade CS, Meshram GK, Warhadpande M, et al. A comparative evaluation of fracture resistance of endodontically treated teeth restored with different post core systems-an in vitro study. J Adv Prosthodont 2011;3(2):90–95. DOI: 10.4047/jap.2011.3.2.90.
  15. Makarewicz D, Ronnlof AM, Lassila LV, et al. Effect of cementation technique of individually formed fiber-reinforced composite post on bond strength and microleakage. Open Dent J 2013;7:68–75. DOI: 10.2174/1874210601307010068.
  16. GC Europe NV. GCA everStick Brochure Operatory. Available from: [Last accessed on 2015 Dec 31].
  17. Guven Y, Tuna E, Dincol M, et al. Long-term fracture resistance of simulated immature teeth filled with various calcium silicate-based materials. Biomed Res Int 2016;2016:2863817. DOI: 10.1155/2016/2863817.
  18. Stuart CH, Schwartz SA, Beeson TJ. Reinforcement of immature roots with a new resin filling material. J Endod 2006;32(4):350–353. DOI: 10.1016/j.joen.2005.08.001.
  19. Katebzadeh N, Dalton BC, Trope M. Strengthening immature teeth during and after apexification. J Endod 1998;24(4):256–259. DOI: 10.1016/S0099-2399(98)80108-8.
  20. Sorensen JA, Martinoff JT. Clinically significant factors in dowel design. J Prosthet Dent 1984;52(1):28–35. DOI: 10.1016/0022-3913(84)90176-8.
  21. Arora C, Aras M, Chitre V. Evaluation and comparison of retention of different esthetic posts. J Indian Prosthodont Soc 2006;6:82–89. DOI: 10.4103/0972-4052.27781.
  22. Tay FR, Pashley DH. Monoblocks in root canals: a hypothetical or a tangible goal. J Endod 2007;33(4):391–398. DOI: 10.1016/j.joen.2006.10.009.
  23. Torabinejad M, Hong CU, McDonald F, et al. Physical and chemical properties of a new root-end filling material. J Endod 1995;21(7): 349–353. DOI: 10.1016/S0099-2399(06)80967-2.
  24. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-part III: clinical applications, drawbacks, and mechanism of action. J Endod 2010;36(3):400–413. DOI: 10.1016/j.joen.2009.09.009.
  25. Grech L, Mallia B, Camilleri J. Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials. Dent Mater 2013;29(2):20–28. DOI: 10.1016/ 1.007.
  26. Sawyer AN, Nikonov SY, Pancio AK, et al. Effects of calcium silicate-based materials on the flexural properties of dentin. J Endod 2012;38(5):680–683. DOI: 10.1016/j.joen.2011.12.036.
  27. Lassila L, Tanner J, Le Bell AM, et al. Flexural properties of fiber reinforced root canal posts. Dental Materials 2004;20(1):29–36. DOI: 10.1016/S0109-5641(03)00065-4.
  28. Callister WD. Materials science and engineering: an introduction to composites. 3rd edn., New York: Wiley; 1997. pp. 513–541.
  29. Seefeld F, Wenz HJ, Ludwig K, et al. Resistance to fracture and structural characteristics of different fiber reinforced post systems. Dent Mater 2007;23(3):265–271. DOI: 10.1016/ 01.018.
  30. Garoushi S, Tanner J, Vallittu P, et al. Preliminary clinical evaluation of short fiber-reinforced composite resin in posterior teeth: 12 months report. Open Dent J 2012;6:41–45. DOI: 10.2174/1874210601206010041.
  31. Sorensen JA, Ahn SG, Berge HX, et al. Selection criteria for post and core materials in the restoration of endodontically treated teeth. Acad Dent Mater 2001;15:67–84.
  32. Beltagy T. Fracture resistance of rehabilitated flared root canals with anatomically adjustable fiber post. Tanta Dent J 2017;14(2):96. DOI: 10.4103/tdj.tdj_16_17.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.