O r i g i n a l A r t i c l e International Journal of Dental Materials 2021; 3(3) ISSN:2582-2209

Evaluation of different custom angulated elastic glass fibre post

on fracture resistance of maxillary central incisor: an in vitro
study
Srikrishna Teja Marisetty1,*, Madhu Varma K2, Girija S Sajjan2, Vishal Babu Kolla1, Nanda Kishore K1,
Mohammad Raheem1

1
Postgraduate Student, 2Professor, Department of Conservative Dentistry and Endodontics, Vishnu Dental
College, Bhimavaram, Andhra Pradesh, India.

I N F O R M A T I O N A B S T R A C T

Background: Restoring Endodontically treated teeth (ETT) can be challenging

Article History
for most dentists, particularly when a significant tooth structure is lost.
Received 21st May 2021 Depending on the coronal tooth structure remaining and the technique used
(direct or indirect), endodontic anchorage can involve either a cast post and core
Received revised
or a prefabricated post.
13th July 2021
Aim: This study aimed to investigate the effect of different custom angulated,
Accepted 20th July 2021 i.e.,0°,5°,10°,15° elastic glass fibre post (Everstick post) on fracture resistance of
maxillary central incisors.
Available online
Materials and methods: Forty A total of forty-eight single-rooted maxillary
1st August 2021
central incisors were selected. All the samples were decoronated 2mm above the
Cemento-Enamel Junction and endodontically treated. Post-space preparation
was done for all the samples using peesoreamers ranging in size from 1-3. The
samples were then randomly divided into four groups (n=12) based on the
different angulations, i.e., the angle between the core and the long axis of the
K E Y W O R D S root, with 0°, 5°, 10°, and 15° angulations, respectively. The fit of each post in the
root canal was verified. Before cementation, the coronal part of each post was
bent according to their respective groups. Dual-cure resin cement was used for
Collum angle luting the posts and cured subsequently. The fracture resistance of all the
samples was evaluated using the universal testing machine after they were
Everstick post
mounted in self-cure acrylic resin blocks. The data were analysed using
Endodontically treated One- way ANOVA and Tukey’s post-hoc test.
teeth Results: Group-I exhibited the highest mean fracture resistance compared to
other groups. However, One-way ANOVA showed no significant differences
Fracture resistance
(p=0.161) between the four groups.
Universal testing machine Conclusion: Everstick fibre posts are a preferable alternative for maxillary central
incisors with core angulations up to 15° between coronal and radicular segments as
they provide better fracture resistance with a more favourable stress distribution.

1. Introduction

The anterior teeth are critical for the aesthetics, occlusal integrity, and phonetics
of an individual [1]. A compromised smile can be evident due to missing, frac-
tured, or discoloured anterior teeth, resulting in a loss of self-esteem [2,3]. The
tooth fracture etiologies include protruded teeth, fall, contact game injuries, and
road traffic accidents [4].
Correspondence: *Corresponding author Email Address: [email protected]
How to cite this article: Marisetty ST, Madhu Varma K, Sajjan GS, Kolla VB, Nanda Kishore K, Raheem Md. Evalu-
ation of different custom angulated elastic glass fibre post on fracture resistance of maxillary central incisor: an
in vitro study. Int J Dent Mater 2021;3(3): 84-89. DOI: http://dx.doi.org/10.37983/IJDM.2021.3303
 International Journal of Dental Materials 2021;3(3): 84 -89
Restoring Endodontically treated teeth (ETT) can glass fibre posts on fracture resistance of maxillary
involve either a cast post and core or a prefabricated central incisors.
post depending upon the remaining coronal tooth
structure [5]. Prefabricated posts may be either metal 2. Materials and methods
or non-metal posts. Analysis of the available literature
shows that the post's primary function is to anchor the The sample size was estimated using G power software
core to the root, providing reinforcement to the root at a 95% confidence interval. The sample size obtained
[5]. for this study was 12 specimens for four groups. So, a
total of 48 teeth were included in the study [11].
The angulation between the root and the crown,
particularly of the single-rooted anterior teeth, is 2.1 Preparation and obturation of root canals
called the Collum angle or an angle formed by the
intersection of the long axis of the crown and root A total of 48 extracted human maxillary central inci-
using the lateral cephalogram is known as Collum sors with single root and single canal were collected
angle [6]. Previous studies demonstrated that the from the Department of Oral and Maxillofacial Surgery,
Collum angle differs among groups with different Vishnu Dental College, Bhimavaram, Andhra Pradesh,
types of malocclusions [7,8]. The orthodontists India. The teeth with calcified canals, cracks or frac-
divided patients into four groups according to Angle's tures, development defects, multiple canals, root car-
classification of malocclusion: class-I, class-II Division- ies, and endodontically treated teeth were excluded. In
I, class-II Division-II, and class-III malocclusions. The order to standardize the samples, the anatomic crowns
average value of the Collum angle for class-I with similar dimensions (i.e., a mesiodistal diameter of
malocclusion is 6.1±5.2, and for class-II division-I 7±1mm and a labiolingual diameter of 6±1mm) were
malocclusions is 5.3±4.2, and for class-II division-2 selected. Teeth were stored in distilled water at room
malocclusions is 10.6±4.4, and 5.6±5.1 for class-III temperature to prevent dehydration until their use,
malocclusions. Compared to groups with other and throughout the study.
malocclusion types, the Collum angle of natural teeth
for patients with class-II division-2 malocclusions All the specimens were decoronated transversally by
were the greatest [9]. preserving 2 mm of tooth structure above the
cementoenamel junction (CEJ) with a double-faced
In addition to the crown-root angle, the labial surface diamond disc. In each tooth, access cavity preparation
of the anterior teeth is comprised of two planes. The was made with Endo Access bur (Dentsply, USA),
two-plane labial surface in the anterior teeth enhances patency was established with 15K file (Mani, Japan).
the aesthetic proportion of the teeth by reducing the Working length was calculated by the visual method
visible segment. During the restoration of the ETT under 2.5X magnification using a Dental operating
with the post in the anterior teeth, dentists should microscope by inserting a 15K file into the canal until
take the crown- root angle and facial angle of the tooth it was first visible at the apical foramen and working
into consideration. Since the fabrication of the length was established 1mm short of this length. Bio-
endodontic post, following the long axis of the root mechanical preparation for all the samples was done in
will lead to proclined incisal edge position in the the crown down technique using ProTaper universal
crown, incompatible contour, and loss of incisal guid- system (Dentsply Maillefer Switzerland). During canal
ance. Hence, it is imperative for the restorative dentist instrumentation, intra-canal irrigation between each
to fabricate the post with a similar crown-root angle of instrument was done with 2 ml of 3% sodium hypo-
the adjacent teeth for optimum rehabilitation [10]. chlorite by using a syringe with 30-gauge side vented
needle tips (Neoendo, India). All canals were finally
To overcome these difficulties, a novel glass fibre post, rinsed with 1mL of 17% Ethylenediaminetetraacetic
Everstick, was introduced. This post is a flexible, resin- acid and followed by a final rinse with distilled water.
impregnated uncured glass fibre with an Interpene- All the canals were dried with paper points. The root
trating Polymer Network (IPN). Limited literature is canals of all the samples were obturated with corre-
available on different custom angulated elastic glass sponding Gutta-percha (Prime Dental, India) by sec-
fibre posts on fracture resistance of maxillary central tional obturation technique with a minimum of 5mm
incisors. Hence, this in vitro study was designed to of apical gutta-percha from root apex using AH Plus
evaluate the effect of different custom-angulated elastic sealer.
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 International Journal of Dental Materials 2021;3(3): 84 -89
Post-space preparation of 10mm in length was done the required angulation by adapting to the glass slab.
1 2 3
with peesoreamers from sizes 1-3. Irrigation was done
with 5ml of 17% EDTA for 15 sec followed by 5ml of 2.3.3 Groups-III and -IV
distilled water and dried with the paper points. All the After post space preparation, the post was placed as
teeth were randomly allocated into the following four described in Group - I and Group - II with 10° and 15°
groups (12 per group). All teeth were to be restored angulations, respectively.
with a 1.5mm diameter Everstick post.
2.4 Post and Core fabrication
Group-I (n=12): The angulation of 0° core to the long
axis of the root. Fibre posts were pre-cured for 20 seconds within the
Group-II (n=12): The angulation of 5° core to the long canal to stabilise the angulation of the post's coronal
axis of the root. portion, then removed and cured for 40 seconds. Then
Group-III (n=12): The angulation of 10° core to the canal spaces of all the specimens were etched with
long axis of the root. 37% phosphoric acid (N etch gel, Ivoclar Vivadent,
Group-IV (n=12): The angulation of 15 °core to the USA) for 15 seconds and then rinsed with distilled
long axis of the root. water and dried using a paper point. The fibre post
was activated by applying an enamel bonding agent
2.2 Placement Procedure of EverStick-Post (StickRESIN GC, Germany), and the post was placed
under a light shield for 3-5 minutes to prevent prema-
Posts were cut together with the silicone strap to the ture curing. Then the post was light-cured for 10 sec.
length of 14mm using sharp scissors. After cutting the Dual Cure Resin Modified GIC cement (Relyx luting 2,
posts to the required length, the posts were removed 3M ESPE, USA) was mixed for 20 seconds and applied
from silicon strips using tweezers, and the length was to the canal walls. A thin layer of cement was placed on
checked by inserting the post into the root canal space the post surface, and the post was inserted into the
so that each post protrudes 4mm from the sectioned canal. Excess cement was removed, and the remaining
tooth surface. For appropriate fitting of the post into cement was light-cured for 40 seconds using a LED
the prepared post space, additional Everstick fibres curing light (Woodpecker, China) at an intensity of 800
were added to the post space. mW/cm2.

2.3 Fabrication and angulation of posts in each After cementation of posts, all the samples were etched
group with 37%phosphoric acid (N etch gel, Ivoclar Vivadent,
USA) for 15seconds and then rinsed with distilled
2.3.1 Group-I water and dried. A bonding agent (Tetric N Bond,
The fit of each post in the root canal was verified; if the Ivoclar Vivadent, USA) was applied with a micro brush,
post does not reach the necessary depth, the apical end and excess was removed with gentle air blow and then
of the post was tapered with sharp scissors to fit in to light-cured for 20 seconds using a LED curing light at
post space. Before cementation, the coronal part of an intensity of 800 mW/cm2 according to the manu-
each post was placed at an angle of 0°. The angle facturer instructions. Then standardized cores were
between the long axis of the radicular part of the post restored using a resin core build-up material (Filtek
segment and the coronal part of the post segment was Z350 nanohybrid composite (3M, ESPE, USA) with a
kept at 0° by placing the teeth along with the post on a height of 8mm measured from labial CEJ. The total
reference paper on which the angulations were drawn core height comprised of 6mm of the core material and
with the help of a protractor. After drawing the refer- a prepared dentine ferrule that measured 2mm labially
ence angulations on a paper, a glass slab is placed in 0° and 1mm proximally.
angulation, and the coronal part of the post segment is
adjusted accurately to the required angulation by For all the samples to simulate the periodontal
adapting to the glass slab. ligament, the roots were wrapped with adhesive tape
to a depth of 2 mm below the CEJ and were mounted in
2.3.2 Group-II self-cure acrylic resin blocks to a level 1mm apical to
After drawing the reference angulations on paper, a CEJ such a way that the coronal part of the post is
glass slab is placed in 5° angulation, and the coronal parallel to the long axis of the mold to make the root
part of the post segment is adjusted accurately to the tilts correspondingly.
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 International Journal of Dental Materials 2021;3(3): 84 -89

Table 1. Mean fracture resistance (in N) and standard deviations of all 4 groups (One-
way ANOVA)
Significance
Groups N Mean ± SD* F - Value
(p-value)
Group-I 12 351.78 ± 115.75
Group-II 12 349.64 ± 105.44
1.799 0.161
Group-III 12 336.93 ± 78.31
Group-IV 12 273.55 ± 74.97
*Standard Deviation

2.5 Testing of samples for fracture resistance greater than 5mm is more likely to suffer from such
dental traumatic injuries [13].
All the specimens were subjected to a fracture
resistance test using a Universal testing machine The utilization of post as a post endodontic restorative
(Instron 8801, United Kingdom) at a crosshead speed technique is usually recommended for mutilated endo-
of 0.5mm per minute. The acrylic blocks were secured dontically treated teeth. If tooth structure loss is more
in a prefabricated jig, which allows the plunger to than 50%, it would determine the use of posts to retain
apply the load on the palatal surface 3mm below to the core and distribute stresses [14]. The primary
the incisal edge at an angulation of 130° to the long function of a post is to retain the core that replaces the
axis of the tooth. The load was applied until the speci- missing coronal structure without compromising the
men was fractured. The obtained data were subjected apical seal of the root canal filling. Ideal post-core
to statistical analysis using Statistical Package for systems are expected to evenly distribute the function-
Social Sciences, Version 22.0, USA. al force along the root surface. For better force distri-
bution, the post should be as long as possible without
3. Results endangering the apical seal [15].

The mean fracture resistance (N) and standard devia- For long-term success, there is a need to conserve the
tions (SD) of all four groups are given in table 1. The remaining healthy root structure. The reason for this
Group–I (0°angulation) demonstrated the highest change of paradigm is to achieve a more conservative
mean fracture resistance followed by groups-II, III and approach with minimally invasive preparation and
IV, respectively (Table 1). One-way ANOVA exhibited maximum tissue conservation, which is considered the
no statistically significant differences (p=0.161) among gold standard for ETT. It is essential to select a post
the groups (Table 1). Posthoc analysis also showed no system that provides maximum retention to the core
statistically significant differences between the groups. and requires removing the minimal amount of tooth
structure. The recently introduced Everstick post
4. Discussion system is a unique post made of impregnated fibres
that can adapt to the shape of any root canal and avoid
The reconstruction of endodontically treated teeth is a extensive preparations.
great challenge in restorative dentistry since the tooth
structure is totally or partially lost by caries, erosion, The maxillary anterior teeth with two plane labial
abrasion, previous restorations, trauma, or endodontic surface and variation in coronal-root curvature neces-
access [12]. The restorations of endodontically treated sitate the fabrication of post with different angulation
teeth are designed to protect the remaining tooth from between coronal and radicular segments [10]. Earlier
fracture, prevent reinfection into the canal system and research reports indicate the significant differences in
replace the missing tooth structure [13]. We often the crown-root angles of maxillary central incisors
come across patients with fractured proclined anterior among various malocclusions. The collum angle is
teeth seeking aesthetic corrections to improve their described to range from 5°-15° between different mal-
smiles. Several studies have reported the predominant occlusion groups [7,8]. Hence the custom post with the
prevalence of traumatic dental injuries in patients hav- crown-root angle of 0°, 5°, 10°, and 15° were selected
ing such proclined teeth. Children and adolescents pre- for evaluation in the study.
senting inadequate lip closure or an increased overjet
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 International Journal of Dental Materials 2021;3(3): 84 -89
The present in-vitro study was done to evaluate the and better stress distribution. The root canal, which is
1 2 3
effect of different custom angulations, i.e., 0°, 5°, 10°, completely filled with fibers is considered as a more
15° of elastic glass fibre post (Everstick post) on effective reinforcement than one post only when com-
fracture resistance of maxillary central incisors. Statis- pared under the same polymerization procedure [18].
tically, no significant difference was observed between
the groups in the mean fracture resistance. This may According to the results from the study, the mean frac-
be due to the close elastic modulus of the Everstick ture resistance had a positive linear correlation with
post to dentin that flexes together under loading force. the decreased angle between the core to the long axis
Also, the dentin-like behaviour of the post facilitates of the root. This could be due to the increased angula-
better stress distribution and yields high fracture tions; the off-axial forces seem to outweigh the axial
strength values. In addition, several factors might forces, resulting in excessive tensile stress concentra-
influence the mechanical properties of FRC posts as tion resulting in decreased fracture resistance as ob-
the type of polymer matrix and length, diameter, tained in this study [13].
number, and fibre-orientation of embedded fibres.
The results obtained in this study were not in accord-
The presence of high molecular weight polymethyl ance with a previous study done to evaluate the frac-
methacrylate (PMMA) chains in the Everstick post act ture resistance of proclined endodontically treated
as a stress-breaker via plasticize the stiffness of highly teeth with cast metal post and Everstick post. The
cross-linked bisphenol A-glycidyl methacrylate matrix results of this study showed that 10°core to the long
(Bis GMA), decrease stress concentration at the inter- axis of the root group showed a mean fracture value
face of fibre-matrix during deflection, and absorption higher than the 0° group. However, there was no stati-
of emerging stresses through the matrix. The silanized cally significant difference between the two groups. In
fibre of Everstick is another essential method for this study, porcelain fused metal crowns were fabricat-
improving the fiber/matrix interface strength [16]. ed for all the specimens. The crowns may act as a
greater equalizer of forces because it tends to change
The multiphase polymer matrix of these Everstick the distribution of forces to the root, post, and core
posts consists of both linear and cross-linked polymer complex, with the post characteristics become insignif-
phases (semi-interpenetration polymer network, icant [19].
semi-IPN). The monomers of the adhesive resins and
cement can diffuse into the linear polymer phase, swell According to Ferrario et al. (2004) [20], the normal
it, and polymerize, form interdiffusion bonding and a biting force exhibited by the maxillary central incisors
so-called secondary semi-IPN structure; this will be is in the range of 93 – 146 N. However, the mean frac-
reduced stress formation at post/dentin and post/ ture strength values obtained in this study were much
cement interfaces [13]. higher than the anterior bite force encountered under
normal clinical loading conditions. So, changing the
The interpenetrating network of Everstick post is core angulation up to 15° can be carried out safely
designed to improve the bond between the post and using Everstick post systems as tested in the study.
the resin and to prevent adhesive failures and microle-
akage. The bonding of the fiber-reinforced post (FRC) However, further in vitro and in vivo studies with larg-
with the Interpenetrating network resin matrix to the er samples and teeth with more complex anatomies
composite resin and adhesive cement was improved are needed to corroborate the results of the present
by an interdiffusion bonding mechanism resulting in a study and to evaluate its clinical efficacy and applica-
“Monobloc” type of restoration [17]. Everstick posts tions.
can be adapted easily to the shape of the root canals,
thereby possibly reducing the number of voids and 5. Conclusion
then the canal completely filled with post; for this
reason, the adhesive surface, and the strength in the Restoration of endodontically treated maxillary central
most critical part of the tooth are maximized [11]. incisors with Everstick post, there was a decrease in
the mean fracture resistance with an increase in core
The Everstick post system allows the additional num- angulation. However, there was no statistically
ber of unpolymerized posts to be added according to significant difference in the mean fracture resistance
the canal morphology, which leads to better adaptation among the four experimental groups, i.e., 0°,5°,10°, 15°
88
 International Journal of Dental Materials 2021;3(3): 84 -89
core angulations. It can be concluded that Everstick 12. Miglani A, Mangat P, Chauhan P, Tomer AK, Nagar-
fibre posts could be an alternative for restoring endo- juna P, Rana S, Dubey S, Mullick S. Comparative
dontically treated maxillary central incisors with core Evaluation of Fractured Resistance of Different Post
System in Endodontically treated Teeth: An in vitro
angulations up to 15°.
Study. Int J Oral Care Res. 2017;5(1):61–64.
https://doi.org/10.5005/jp-journals-10051-0083
Conflicts of interest: Authors declared no conflicts of
13. Dutta A, Nadig RR, Gowda Y. To evaluate the frac-
interest. ture resistance of proclined endodontically treated
Financial support: None teeth with different post and core systems: In vitro
study. J Conserv Dent. 2020;23(3):233-239.
References https://doi.org/10.4103/JCD.JCD_366_20
14. Faria AC, Rodrigues RC, de Almeida Antunes RP, de
1. Ingber FK. You are never fully dressed without a Mattos MD, Ribeiro RF. Endodontically treated teeth:
smile. J Esthet Restor Dent. 2006;18(2):59–60. characteristics and considerations to restore them. J
https://doi.org/10.2310/6130.2006.00011.x Prosthodont Res. 2011;55(2):69-74.
2. Davis LG, Ashworth PD, Spriggs LS. Psychological https://doi.org/10.1016/j.jpor.2010.07.003
effects of aesthetic dental treatment. J Dent. 1998;26 15. Arora C, Aras M, Chitre V. Evaluation and compari-
(7):547-54. son of retention of different aesthetic posts. J Ind
https://doi.org/10.1016/S0300-5712(97)00031-6 Prosthodont Soc. 2006;6(2):82-89.
3. Dong JK, Jin TH, Cho HW, Oh SC. The esthetics of https://doi.org/10.4103/0972-4052.27781
the smile: a review of some recent studies. Int J Pros- 16. Beltagy TM. Fracture resistance of rehabilitated
thodont. 1999;12(1):09-19 flared root canals with anatomically adjustable fiber
4. Toprak ME, Tuna EB, Seymen F, Gençay K. Trau- post. Tanta Dent J. 2017;14(2):96-103.
matic dental injuries in Turkish children, Istanbul. https://doi.org/10.4103/tdj.tdj_16_17
Dental Traumatol. 2014;30(4):280-4. 17. Cormier CJ, Burns DR, Moon P. In vitro comparison
https://doi.org/10.1111/edt.12092 of the fracture resistance and failure mode of fiber,
5. Spazzin AO, Galafassi D, de Meira-Júnior AD, Braz ceramic, and conventional post systems at various
R, Garbin CA. Influence of post and resin cement on stages of restoration. J Prosthodont.2001;10(1):26-36.
stress distribution of maxillary central incisors re- https://doi.org/10.1111/j.1532-849X.2001.00026.x
stored with direct resin composite. Oper Dent. 18. Hegde V, Arora N. Fracture Resistance of Endodonti-
2009;34(2):223-9. https://doi.org/10.2341/08-73 cally Treated Teeth Restored Using Three Different
6. Delivanis HP, Kuftinec MM. Variation in morpholo- Esthetic Post System. J Oper Dent Endod. 2019;4
gy of the maxillary central incisors found in class II, (1):10-13.
division 2 malocclusions. Am J Orthod. 1980;78 https://doi.org/10.5005/jp-journals-10047-0066
(4):438-43. 19. Assif D, Oren E, Marshak BL, Aviv I. Photoelastic
7. Williams A, Woodhouse C. The crown to root angle analysis of stress transfer by endodontically treated
of maxillary central incisors in different incisal clas- teeth to the supporting structure using different restor-
ses. Brit J Orthod. 1983;10(3):159-61. https:// ative techniques. J Prosthet Dent. 1989;61(5):535-43.
doi.org/10.1016/0002-9416(80)90024-X https://doi.org/10.1016/0022-3913(89)90272-2
8. McIntyre GT, Millett DT. Crown-root shape of the 20. Ferrario VF, Sforza C, Serrao G, Dellavia C, Tar-
permanent maxillary central incisor. Angle Orthod. taglia GM. Single tooth bite forces in healthy young
2003;73(6):710-5. adults. J Oral Rehabil. 2004; 31:18–22
9. Shen YW, Hsu JT, Wang YH, Huang HL, Fuh LJ. https://doi.org/10.1046/j.0305-182X.2003.01179.x
The Collum angle of the maxillary central incisors in
patients with different types of malocclusions. J Dent
Sci. 2012 Mar 1;7(1):72-6.
https://doi.org/10.1016/j.jds.2012.01.010
10. Haralur SB, Lahig AA, Al Hudiry YA, Al-Shehri AH,
Al-Malwi AA. Influence of post angulation between a
coronal and radicular segment on the fracture re-
sistance of endodontically treated teeth. J Clin Diagn
Res. 2017;11(8): ZC90-ZC93.
https://doi.org/10.7860/JCDR/2017/27965.10470
11. Chakmakchi M, Rasheed R, Suliman R. In vitro com-
parative assessment of facture resistance of roots re-
stored with everstick fiber reinforced composite post.
J Oral Dent Res. 2015;2(1):43-50.
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