Statement of problem: The influence of different crown foundations on marginal seal and fracture resistance of ceramic crowns placed on endodontically treated teeth has not been clearly established.
Purpose: The purpose of this study was to evaluate the marginal continuity and fracture behavior of high-strength all-ceramic crowns with different substructures in endodontically treated premolars.
Material and methods: Forty-eight human mandibular premolars were assigned to 6 groups, including a no-treatment group (UNTREATED) and a group for which the access cavity was restored with composite resin (Tetric Ceram) (COMP). In the remaining 4 groups, teeth were prepared to receive all-ceramic crowns with 0.8-mm-wide shoulders and axial dentin heights of 2 mm. No posts were used in the ENDOCROWN group. Glass fiber posts (FRC Postec) were used in group FRC-POST. Group ZRO-POST received zirconia ceramic posts (CosmoPost), and group GOLD-POST received cast gold posts (CM). Experimental lithia disilicate ceramic crowns were made and adhesively cemented (Variolink). All teeth were subjected to thermal cycling and mechanical loading (TCML) in a masticatory simulator (1,200,000 loads, 49 N, 1.7 Hz, 3000 temperature cycles of 5 degrees C-50 degrees C-5 degrees C). Marginal continuity was evaluated with scanning electron microscopy at x200. All specimens were loaded to failure in a universal testing machine at 0.5 mm/min after TCML. Data were analyzed using 1-way ANOVA and post hoc t tests with Bonferroni correction (alpha=.05).
Results: Initially, mean values (SD) between 72.4 (15.8)% (ENDOCROWN) and 94.8 (3)% (FRC-POST) for continuous margins were found. With TCML, marginal continuity decreased significantly only in FRC-POST, to 75.5 (8.4)%, and in ENDOCROWN, to 44.7 (14.5)%. Mechanical load testing measured mean loads to failure between 1092.4 (307.8) N (FRC-POST) and 1253.7 (226.5) N (ZRO-POST) without significant differences between groups. Deep root fractures were observed in half of the specimens, irrespective of their groups.
Conclusions: Marginal continuity of the crowns studied was better and more stress resistant when posts and cores were included in the restoration of endodontically treated teeth with complete ceramic crowns. The placement of a post-and-core foundation did not influence the pattern of failure.