Ó

Operative Dentistry, 2019, 44-6, E299-E308

Effect of Ferrule Thickness

on Fracture Resistance of
Teeth Restored With a Glass Fiber

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Post or Cast Post
PE Fontana  TC Bohrer  VF Wandscher  LF Valandro  IF Limberger  OB Kaizer

Clinical Relevance
A tooth without a ferrule presented more favorable failures than with a 1-mm-thick ferrule
when restored with a cast post and core, despite an increased fracture resistance. The
findings support the use of a glass fiber post.

SUMMARY height). The root posts and the metal crowns

Purpose: To investigate the influence of fer- were cemented using an adhesive cement. The
rule thickness on fracture resistance after samples were subjected to mechanical cycling
mechanical cycling of teeth restored with (at 378C, 458, 130 N, 2.2 Hz, and 2 3 106 pulses).
Afterward, they were subjected to a fracture
different intracanal posts.
load test at a speed of 0.5 mm/min and on a 458
Methods and Materials: One hundred twenty slope until failure occurred. The failures were
bovine incisor teeth were randomized into six classified as favorable or unfavorable. The
study groups, based on the intracanal post fracture resistance data were analyzed with
used (fiber post or cast post and core) and the two-way analysis of variance and Tukey test.
presence and thickness of a ferrule (without The chi-square test was used to analyze the
ferrule, presence of 0.5-mm or 1-mm-thick pattern of failure.
ferrule, retaining unaltered 2-mm ferrule Results: When considering the cast post and
*Patrı́cia Eliana Fontana, MSD, DDS graduate student in core, the 1-mm ferrule thickness group pre-
Oral Sciences (Prosthodontics), Faculty of Odontology,
Inácio F Limberger, PhD, associate professor, Faculty of
Federal University of Santa Maria, Santa Maria, Brazil
Mechanical Engineering, Federal University of Santa Maria,
Thaı́s Camponogara Bohrer, MSD, DDS graduate student in Santa Maria, Brazil
Oral Sciences (Prosthodontics), MSD, Faculty of Odontology,
Osvaldo Bazzan Kaizer, MSD, PhD, adjunct professor, MDS
Federal University of Santa Maria, Santa Maria, Brazil
Graduate Program in Oral Science (Prosthodontics Units),
Vinı́cius Felipe Wandscher, MSD, PhD, adjunct professor, Faculty of Odontology, Federal University of Santa Maria,
Faculty of Odontology, Franciscan University (Prosthodon- Santa Maria, Brazil
tics Unit), Santa Maria, Brazil
*Corresponding author: Floriano Peixoto Street, 1184, 97015-
Luiz Felipe Valandro, MSD, PhD, associate professor, MDS 372, Santa Maria, Brazil; e-mail: patricia_fontana_@hotmail.
Graduate Program in Oral Science (Prosthodontics-Biomate- com
rials Units), Faculty of Odontology, Federal University of
DOI: http://doi.org/10.2341/18-241-L
Santa Maria, Santa Maria, Brazil
E300 Operative Dentistry

sented a higher resistance to fracture than did

the group in which a ferrule was not used
(p=0.001). When using a glass fiber post, the
groups showed no differences in fracture re-
sistance. Overall, 96.7% of the specimens sur-
vived the mechanical cycling. Of the fractures,
58.6% of the fractures were unfavorable, while
41.6% were favorable.
Conclusions: A thicker ferrule statistically

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increased the fracture resistance only for cast
post and core when it was at least 1 mm thick,
despite causing more unfavorable failures.
Thus, ferrule thickness should be considered
when choosing different intracanal posts, to
reduce the occurrence of unfavorable failures.
In the absence of a ferrule, the use of a cast
post and core presents more favorable failures,
and in the presence of a 1-mm-thick ferrule,
the use of a glass fiber post seems to be the best
clinical decision.

INTRODUCTION
The prognosis of endodontically treated teeth de- Figure 1. Schematic diagram of the marking of the ferrule thickness
and experimental groups.
pends on several factors, such as adequate coronal
reconstruction,1 tooth position in the dental arch,
type of final restoration, post length and thickness, because of existing carious lesions.7 For instance,
and the presence of a ferrule.2 A ferrule is composed ceramic restorations commonly require that the
of parallel walls of dentin from the crown’s margin remaining dentin thickness at the margins of the
extending coronally to the fractured part of the tooth preparations are reduced by at least 1.5 mm to
(see Figure 1).2,3 Fabricating a crown around the achieve desirable esthetics.7,12
remaining structures and generating a ferrule Although it has been accepted clinically that a
effect2-4 may reduce intraradicular stress and thus ferrule thickness of 1 mm is considered very thin,7
the incidence of fractures.5 there are only a few studies in the literature
The clinical outcome is significantly influenced by reporting the effect of remaining coronal thickness
the amount of residual coronal dentin,6 and the on the mechanical behavior of endodontically treated
existing literature extensively describes the impor- teeth.13,14 Tjan and Whang13 reported that there was
tance of having adequate ferrule height.7 Studies no significant difference among the groups that had
have demonstrated that a minimum ferrule height of remaining buccal dentin of varying thickness of 1
1.5-2 mm shows improvement in the longevity of mm, 1 mm with a 608 bevel, 2 mm, and 3 mm.
endodontically treated teeth restored with post and However, a dentin thickness of 1 mm resulted in a
core2,7,8 and also provides better fracture resis- higher incidence of failure due to fracture rather
tance.7,9 than cement failure.13 In addition, Joseph and
Ramachandran14 studied the effectiveness of incor-
The influence of ferrule thickness on clinical
porating the thickness of coronal dentin and con-
outcome is also a topic that needs to be explored
cluded that fracture resistance increased in the case
further.7 The amount of residual axial tooth struc-
of 2-mm-thick remaining dentin.14 On the other
ture to be significant in fracture resistance has been
hand, there are no studies in the literature evaluat-
reported in the literature7,10,11; however, some
reports have excluded the width of shoulder prepa- ing the effect of 0.5-mm ferrule thickness on
ration and crown margin as significant factors. The resistance to fracture.7
shoulder preparation could compromise the thick- Thus, the objective of this research was to evaluate
ness of the buccal dentinal wall when esthetics the influence of the remaining coronal thickness
require more invasive preparations at the margin or (without ferrule, 0.5-mm thickness, and 1-mm
Fontana & Others: Ferrule Thickness and Fracture Resistance of Restored Teeth E301

Table 1: Study Design

To avoid differences in tooth size among the
groups, the mesiodistal and vestibular-lingual di-
Study Factors Group mensions of the teeth were measured with the aid of
Kind of Thickness of Ferrule Code
digital calipers (Starrett 727, Starrett, Itu, São
Root Posts
Paulo, Brazil), and the measurements were tabulat-
Glass fiber post No ferrule GFP-0
ed. The data were verified to be normally distribut-
Ferrule with a height of 2 mm GFP-0.5 ed. Subsequently, a one-way analysis of variance
and a thickness of 0.5 mm
(ANOVA) was performed to verify differences in the
Ferrule with a height of 2 mm GFP-1
and a thickness of 1 mm measured dimensions between the groups. No

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Cast post and No ferrule CPC-0 statistically significant difference (a=0.05) in the
core Ferrule with a height of 2 mm CPC-0.5
dimensions of the teeth could be detected.
and a thickness of 0.5 mm
Ferrule with a height of 2 mm CPC-1 Periodontal Ligament Confection and
and a thickness of 1 mm Endodontic Treatment
To simulate the periodontal ligament and the
thickness) on the resistance to fracture of endodon- biological space, the roots were coated with a layer
tically treated teeth with a glass-fiber post or cast of wax (Lysanda, São Paulo, Brazil) of 0.3-mm
post and core. The null hypothesis was that ferrule thickness (measured by digital calipers; Starrett
thickness has no influence on the fracture resistance 727, Itu). For this purpose, the wax was liquefied
of endodontically treated teeth restored with differ- in a container at a standard temperature of 708C,
ent intracanal posts after mechanical cycling and and each tooth was placed inside up to 3 mm below
fracture load test. the most coronal portion of the root. Then, each tooth
was embedded in a polyvinyl chloride cylinder
METHODS AND MATERIALS (height of 20 mm and diameter of 25 mm) with
self-cured acrylic resin (VIPI Flash, VIPI, Pirassu-
Selection of Specimens
nunga, São Paulo, Brazil) up to 3 mm below the most
The number of teeth to be used in the present coronal portion of the root, simulating the biologic
research was determined by performing a sample space. Afterward, the tooth was removed from the
calculation with the OpenEpi 3.01 program,15 with acrylic resin and the wax was removed, creating a
the parameters used previously in a study by space corresponding to the periodontal ligament.
Wandscher and others.16 The power of the study Subsequently, the impression material was manip-
was defined as 80%, with a level of significance of ulated as recommended by the manufacturer and
0.05, identifying the need for 15 teeth per group. inserted into the artificial alveolus. The tooth was
However, because of the variability of bovine teeth, placed into its respective alveolus, and excess
radicular anatomy, and possible variability in the impression material was removed; thus, the elasto-
preparation of the ferrule, 20 teeth were allocated to meric material (Impregum F, 3M-ESPE, Seefeld,
each group. Germany) mimicked the periodontal ligament.17
One hundred twenty bovine incisor teeth were Afterward, the root was prepared using the step-
selected and analyzed for possible fractures, cracks, back technique, using second- and third-series
and fissures, with the aid of a loupe (43 magnifying, endodontic files (Dentsply-Maillefer, Ballaigues,
EyeMag Pro S, Carl Zeiss, Gottingen, Germany). Switzerland) and Nos. 3, 4, and 5 Gates-Glidden
Afterward, the selected teeth were randomized burs (Dentsply-Maillefer). The specimens were filled
through the website random.org into six groups with AH plus sealer (Dentsply-Maillefer), and the
(n=20 in each) based on the post type (glass fiber root canals were obturated with gutta-percha cones
post [GFP] or cast post and core [CPC]) and features (Dentsply-Maillefer). The compaction technique
of the ferrule (Table 1). used was cold lateral condensation with a force of
Thereafter, the coronal portion of each tooth was 2000g standardized through a digital scale.18 The
sectioned at a distance of 16 mm (in the absence of a specimens were stored in deionized water at 378C for
ferrule, CPC-0 and GFP-0) or 18 mm (in the presence 24 hours.
of a 2-mm-high ferrule, with varying thickness, CPC-
0.5, CPC-1, GFP-0.5, and GFP-1) from the root apex, Intracanal Preparation for Post Seat
resulting in a standard height. All procedures were A post space (cementation length) of 12 mm was
performed by two trained researchers. prepared for the groups without ferrule (CPC-0,
E302 Operative Dentistry

GFP-0), and 14 mm preparation was used for the applied according to the manufacturer’s guidelines.
groups with ferrule (GFP-0.5, GFP-1, CPC-0.5, CPC- Finally, the posts were cemented with dual-cure
1). For the GFP-0, GFP-0.5, and GFP-1 groups, the resin cement (Allcem, FGM), which was also manip-
preparation was initially performed by No. 4 Largo ulated as recommended by the manufacturer.
burs (Dentsply Maillefer) and finished with stan- The cores (for glass fiber post samples) were
dardized drills of the Whitepost DC No. 2 fiberglass fabricated with a composite resin (Opallis, FGM)
post system (FGM, Joinville, Brazil). For the CPC-0, with acetic matrix (identical to that used for the
CPC-0.5, and CPC-1 groups, the post space was CPC-0 groups). The matrix was filled with incre-
prepared using Nos. 3, 4, and 5 Largo burs (Dentsply ments of composite resin and adapted over the

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Maillefer). coronal portion of the post. Afterward, the matrices
were sectioned and the composite resin was photo
Preparation of Ferrule activated (1200 mW/cm2; Radiical, SDI, Victoria,
The ferrules in the GFP-0.5, GFP-1, CPC-0.5, and Australia) on each side of the tooth for 10 seconds.
CPC-1 groups were manually prepared with a For all groups, metallic full crowns (Ni-Cr alloy;
diamond bur (No. 3216, KG Sorensen, Barueri, Wirona light, Bego, Goldschlagerei, Germany) were
Brazil) using a high-speed hand piece (Extra Torque prepared with standardized shape and dimensions,
605C; Kavo do Brasil, Joinville, Brazil) with water according to the anatomy of a maxillary canine. After
spray cooling, resulting in the corresponding thick- that, the crowns were evaluated and air-abraded
ness of each group and standard height of 2 mm. For with aluminum oxide (110 lm, pressure 2.8 bars, 10-
this, the thickness and height to be removed were mm distance, and 15 seconds).
marked with graphite with the aid of a digital caliper
(Starrett 727, Itu; Figure 1). Before the crowns were cemented, they were
cleaned with absolute alcohol. The dentin and core
Production of the Cast Post and Cores (composite and metal) surfaces were etched with
37% phosphoric acid for 15 seconds, followed by
The standards for the cast post and core were rinsing with air-water spray and drying with
obtained by molding the root canals with chemically absorbent paper, and the adhesive Ambar (FGM)
activated acrylic resin Bosworth Trim Plus (Bos- was applied according to the manufacturer’s guide-
worth Company, Skokie, IL, USA) and prefabricated lines. The full-metal crowns were cemented with a
plastic posts (Pinjet, Ângelus, Londrina, Paraná, dual-cure resin cement (Allcem, FGM), according to
Brazil). For preparation of the coronal part of the the manufacturer’s guidelines. Next, a 5-kg load was
core, acetic matrices were used.
applied on each metal crown by means of a static
Resin patterns were handed over to a commercial press, during cementation. Excess cement was
laboratory for casting. Next, the cast post and cores removed after three minutes, and photo-activation
were evaluated for adaptation. was carried out (1200 mW/cm2, Radiical, SDI) on
each side of the tooth for 10 seconds. The samples
Cementation of the Posts and Crowns were stored for 24 hours before testing.
Prior to post cementation, the intracanal surfaces of
the cast post and cores were air-abraded with Mechanical Cycling
aluminum oxide particles (110 lm, pressure 2.8 The specimens were subjected to mechanical cycling
bars, 10-mm distance and 15 seconds; Blue, São José (Erios ER 3000, São Paulo, Brazil) for the aging, with
do Rio Preto, Brazil). the following protocol: 2.2-Hz frequency, 2 million
For the glass fiber post groups and cast post and load pulses from 0 N to 130 N, immersion in water at
core groups, 7 mm of the coronal portion of the post 378C temperature, and piston at a 458 angle with
was retained. All surfaces of each glass fiber post respect to the long axis of the root and at 2 mm
were cleaned with 70% alcohol. Next, a silane distance from the lingual incisal edge. Thus, in this
coupling agent (Prosil, FGM, Joinville, Santa Cata- trial, approximately two years of clinical service was
rina, Brazil) was applied to each post, and the simulated, since Wiskott and others19 determined
solvent was allowed to evaporate for five minutes. that 1 million cycles correspond to one year of service.
All root posts were cemented using the same
procedures: the root canal and the coronal portions Fracture Load Test
were prepared using 37% phosphoric acid (Condac After mechanical cycling, the specimens were ana-
37, FGM), and the adhesive Ambar (FGM) was lyzed for the presence of fractures, and those that did
Fontana & Others: Ferrule Thickness and Fracture Resistance of Restored Teeth E303

(a=0.05). In addition, the chi-square test was used to

analyze the association between the different pat-
terns of failure and the different groups.

RESULTS
Mechanical Cycling
In total, 96.7% of the specimens survived mechanical
cycling. In the GFP-0 group, two failures occurred, one

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being favorable, presenting a crack at the vestibular
region and detachment of the crown from the lingual
region, and one unfavorable, with cracks at the
proximal and lingual regions, besides displacement
Figure 2. Schematic diagram of failures. (A) Failure unfavorable. (B) of the crown from the lingual region. The unfavorable
Failure favorable. fracture occurred in the GFP-0.5 group with cracks at
the proximal region and displacement of the crown
not present with cracks were subjected to the from the lingual region. In the CPC-0.5 group, only an
fracture load test in a universal test machine (DL adhesive failure was observed in the lingual region. In
2000, Emic, São José dos Pinhais, Brazil). Each the CPC-0, GFP-1, and CPC-1 groups, there were no
sample was positioned on a fixed metal device and failures during cycling (Table 2).
aligned at a 458 angle, under 0.5 mm/min until
failure occurred. The cylindrical metallic tip (diam- Fracture Load
eter 0.8 mm) attached to the load cell (1000 kN) was Table 3 shows the fracture load data (N). The Tukey
applied as a lingual load (2 mm from the lingual test showed a significant difference between the
incisal edge). A load point at which the force resulted groups CPC-0 and CPC-1 (p=0.001). The other
in root fracture, post curvature, or core and post groups did not demonstrate significant differences.
displacement was defined as the threshold of failure.
Failure Analysis
Failure Analysis
Table 2 enumerates the failures that occurred during
The roots were stained superficially with hydro- the fracture load test and mechanical cycling, in
graphic pens (Blue overhead marker, Faber-Castell, addition to the location of fracture. Of the fractures,
São Carlos, Brazil), after the fracture load test. The 58.6% of the fractures were unfavorable, while 41.6%
excess ink was then removed with cotton and 70% were favorable. In the groups that used a glass fiber
alcohol, and the specimens were visualized with a post, the GFP-1 group showed the most favorable
stereomicroscope at 103 magnification (Stereomicro- failures (60.0%), while among the groups that used
scope Discovery V20; Carl Zeiss, Germany). The the cast post and core, the CPC-0 group presented
failures were classified as favorable (ie, above the 3- more favorable failures (80.0%). After the fracture
mm limit of the acrylic resin, up to the limit of the load test, the surface that presented the most cracks
simulated cemento-enamel junction [CEJ]) and in the radicular third was the distal surface, followed
unfavorable (ie, below the aforementioned limit, by the mesial. Furthermore, displacement of the
below the CEJ; Figure 2). Fractured specimens were lingual portion of the crown occurred in 82% of the
transversely sectioned in a cutting machine (Isomet specimens.
1000 Precision Saw, Buehler, Lake Bluff, IL, USA)
The pattern of failure was analyzed using the chi-
with a diamond saw, making it possible to inspect
square test (Table 4). When comparing groups that
the crack and its features.
used the same type of post but different thicknesses
of the ferrule, it was observed that in the glass fiber
Data Analysis post groups, only the GFP-0.5 and GPF-1 groups
Using the Shapiro-Wilk test, the fracture load data showed a statistically significant difference between
were analyzed for their distribution, while their them (p=0.01); among the groups that used a cast
homogeneity was analyzed using the Levene test. post and core, there was a statistical difference
They were found to have a homogeneous and normal between the CPC-0 and CPC-0.5 groups (p=0.001)
distribution (p.0.05). Then, the fracture load data and between the CPC-0 and CPC-1 (p=0.001)
were submitted to two-way ANOVA and Tukey tests groups. On the other hand, when comparing groups
E304 Operative Dentistry

Table 2: Qualitative Evaluation of Failures After Mechanical Cycling and Fracture Load Test
Study Group, n (%)
GFP-0 GFP-0.5 GFP-1 CPC-0 CPC-0.5 CPC-1 Total
Failures during mechanical cycling
Pattern of failure
Favorable 1 — — — 1 — 2
Unfavorable 1 1 — — — — 2
Failure place

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Crown displacement (lingual) 2 1 — — — — 3
Mesial crack 1 1 — — — — 3
Buccal crack 1 — — — — — 1
Distal crack 1 1 — — — — 2
Lingual crack 1 — — — — — 1
Fracture in the post — — — — — — —
Crown, core, post pull out — — — — 1 — 1
Failures after fracture load
Pattern of failure
Favorable 8 (44.4) 4 (21.1) 12 (60.0) 16 (80.0) 4 (21.1) 4 (20.0) 48 (41.4)
Unfavorable 10 (55.6) 15 (78.9) 8 (40.0) 4 (20.0) 15 (78.9) 16 (80.0) 68 (58.6)
Failure place
Crown displacement (lingual) 17 15 19 14 16 17 98
Mesial crack 11 16 15 10 15 16 83
Buccal crack 8 3 10 9 8 15 53
Distal crack 13 16 16 6 16 18 85
Lingual crack 1 — — 1 — 3 5
Fracture in the post — — — — 1 1
Crown, core, post pull out 2 1 — 5 3 3 14
Failure mode
Mesiodistal 10 16 15 6 11 16
Buccolingual — — — — — 1

with different types of posts but the same ferrule The mechanical cycling of the specimens was
thickness, the groups with a 0.5-mm-thick ferrule performed by simulating an aging condition close to
presented no differences among them, while the a real-life situation. Applying 2 million cycles
other groups presented differences. simulated approximately two years of clinical ser-
vice.19 We found that 96.7% of the specimens
DISCUSSION survived the mechanical cycling. Two failures in
the GFP-0 group and one in the GFP-0.5 group were
The present study showed that remaining coronal reported on analysis of the failures that occurred
thickness affected the fracture resistance of end- following mechanical cycling in the groups that used
odontically treated teeth that were restored using a glass fiber posts. However, the group with the
cast post and core. Thus, the null hypothesis was highest ferrule thickness (GFP-1) exhibited no
rejected. failure, which corroborates that the greater the

Table 3: Mean (6 Standard Deviation) of the Results of Fracture Load (N) Test and Tukey’s Testa
Post Thickness of Ferrule
Without Ferrule 0.5 mm 1 mm
Glass fiber post 352.66 6 219.02 aA 462.39 6 272.65 aA 474.30 6 219.67 aA
Cast post and core 339.04 6 153.78 aB 483.69 6 342.77 aAB 575.72 6 214.34 aA
a
Uppercase letters compare groups with the same intracanal post but different ferrule thickness (rows). Lowercase letters compare groups with the same ferrule
thickness but different intracanal post (column).
Fontana & Others: Ferrule Thickness and Fracture Resistance of Restored Teeth E305

Table 4: Association Between Groups and Pattern of

stored with a glass fiber post and 1-mm-thick
Failures, Chi-Square Testa ferrules when compared with teeth treated endodon-
tically and restored with glass fiber posts without
Pattern of Thickness of Ferrule, %
Failure
ferrules.
Without Ferrule 0.5 mm 1 mm
Glass fiber post ABb Ba Aa
The chi-square test (Table 4), using the proportions
of failure pattern in each group, was performed to
Favorable 44.44 20 60
determine whether there was a difference in the
Unfavorable 55.56 80 40
failure mode between different types of posts and
Cast post and core Aa Ba Bb
ferrule thicknesses. When the specimen had no

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Favorable 80 21.05 20
ferrule—in the GFP-0 (44.4% favorable failures) and
Unfavorable 20 78.95 80
a
CPC-0 groups (80.0% favorable failures; p=0.02)—the
Uppercase letters compare groups with the same intracanal post but
different ferrule thickness. Lowercase letters compare groups with the same cast post and core could be used because there were
ferrule thickness but different intracanal post. more favorable failures. When the specimen had a
0.5-mm-thick ferrule, either of the post types could be
ferrule thickness, the higher the chance of longer used because there was no statistically significant
tooth survival without failure. difference between their failure patterns (p=0.77). In
contrast, with a 1-mm-thick ferrule, a fiber post
The CPC-0 and CPC-1 groups presented a signif-
(60.0% favorable failures) will be more suitable than a
icant difference in the fracture resistance test, since
cast post and core (20.0% favorable failures; p=0.01).
the CPC-1 group had a higher value of fracture
resistance, followed by the CPC-0.5 group and, According to Santos and others,20 in order to choose
finally, the CPC-0 group. However, there was no a suitable technique to restore endodontically treated
significant difference when the thickness varied by maxillary incisor teeth, we must take into account the
only 0.5 mm (CPC-0 for CPC-0.5; CPC-0.5 for CPC-1; amount of dental structure remaining and the
Table 3). This can be explained by the small increase esthetic and functional considerations. Furthermore,
in ferrule thickness (0.5 mm) because clinically, the there is evidence in the literature supporting the
coronal walls are considered to be very thin when clinical choice of glass fiber post when there is more
they are less than 1-mm thick.7 Furthermore, the remnant coronal structure and cast post and core
number of unfavorable failures also increased when when there is none.22,25,26 In this study, we observed
the ferrule thickness reached 0.5 mm or 1 mm (Table that the CPC-0 subgroup had a higher percentage of
2). The possible reason for this was an increase in favorable failures than the GFP-0 subgroup, and the
the fracture resistance with a thicker ferrule. GFP-1 subgroup had more favorable failures than the
Moreover, an increase in unfavorable failures can CPC-1 subgroup (Table 4), which agree with the
also be explained by the high modulus of elasticity of results reported in the literature. Figure 1 shows that
nickel-chromium (Ni-Cr) that can concentrate stress- the teeth without any coronal remnant could probably
es through the post and core into the walls of the root suffer from more bending than those with some
canals.20,21 remnant. It is stated that the fiber post concentrated
stresses at the cervical level27; hence, the stress
On analysis of the groups that used glass fiber
posts, no increase in fracture resistance was found distribution to dentin in this region is higher.
with increasing ferrule thickness (Table 3). This may However, when the ferrule effect exists, the fiber post
be due to better stress distribution by the glass fiber presents with less tendency to bend.
post as compared with the cast post and core.22 In Recently, Wandscher and others analyzed flared
accordance with these results, in a classic study by roots restored with different types of posts that
Sorensen and Engelman,23 it was shown that the fractured after cyclic and static loading (demonstrat-
axial width of the tooth at the crown margin did not ed by means of fractographic analysis) and found
significantly increase the fracture resistance or alter that the final fracture was a consequence of tensile,
the failure threshold. In addition, a clinical study by compression, and shear stresses.16 Taking into
Mancebo and others24 demonstrated that endodon- consideration the interpretation of the fractured
tically treated teeth with a ferrule, that were surface, failure analysis revealed the direction of
restored with glass fiber posts, showed better clinical crack propagation, thus recognizing the origin or
survival after 3 years of clinical service compared cause of failure.28 The origin of the fracture may be a
with nonferrule teeth. In agreement with Macebo location, a specific flaw, or an irregularity. The
and others,24 in this study, the failures were more nature of loading (tensile, bending, shear, torsion,
favorable in the endodontically treated teeth re- and fatigue), microstructure of the material, envi-
E306 Operative Dentistry

ronment factors, and stress concentrators indicate

the appearance of marks at the location of the origin
of the failure.29 A few studies of endodontically
treated teeth restored with posts present a detailed
analysis of the fractured specimens. Therefore, only
a few studies have evaluated in detail the fractured
surfaces of teeth with remaining coronal structure
(the ferrule effect). However, those results strongly
suggest that the remaining coronal thickness might

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influence the stress distribution on the tooth/post/
crown, consequently affecting its fracture resistance
and the mode of fracture.
In relation to the failure pattern, it is observed
that the roots fractured at similar rates (Table 2) as
those in the study by Wandscher and others,16
presenting mesiodistal cracks independent of the
type of post used. This feature is a consequence of
the loading mode of the specimens (458). Biomechan-
ical studies demonstrated that restored teeth sub-
jected to oblique loads suffered tensile (lingual
surface) and compression (buccal surface) forc-
es.16,30,31 These tensions are maximal in the external
portions (lingual and vestibular) and minimal in the
center of the restorative set (root canal). The authors
stated that a sequence of events led to the final
fracture, such as shear stresses on the post-dentin
adhesive interface that caused decementation of the
assembly (crown displacement); thus, the post
becomes loose in the canal, no longer acting as a
unique structure and breaking on the buccal wall
due to higher compressive stress.
In the current study, it was observed that the
presence of the ferrule effect on a restored tooth with
a post altered the arrangement of the forces acting
on the restored tooth (without ferrule effect vs with
ferrule effect groups). A tooth with a cervical ferrule
presents a coronal displacement of the fulcrum line,
decreasing the effect of flexion (bending moment)32
and protecting the specimen (Figure 3). This fact
explains why teeth with a ferrule effect present a
higher loading fracture.

multiplying the force applied by the distance between the point of

application of the load and the fulcrum line); F: applied force; D:
distance from the point of application of the load to the fulcrum line;
M1: bending moment referring to the fulcrum 1; M2: bending moment
relative to fulcrum 2; dentine volume: volume of coronary remaining
present in specimens with the presence of ferrule.

Figure 4. (A): Specimens of the glass fiber post group or cast post and
Figure 3. Schematic representation of a restored tooth with a post core group without a ferrule. (B): Specimens of the glass fiber post group
~: force exerted on the specimen (458);
subjected to an oblique force. F or cast post and core group with a ferrule. Schematic drawing of the
fulcrum 1: fulcrum formed when there is no ferrule present in the ~: force exerted on
ultimate fracture without and with ferrule specimens (F
specimen (GFP-0 and CPC-0 groups); fulcrum 2: fulcrum formed the specimen (458); F ~y: vertical component of F; F ~x: horizontal
when there is presence of ferrule in the specimen (groups GFP-0.5, component of F; d1: distance from the point of application of the load
GFP-1, CPC-0.5 and CPC-1). M: bending moment (measured by to the specimen; M1: bending moment of the specimen, red line).
Fontana & Others: Ferrule Thickness and Fracture Resistance of Restored Teeth E307

Comparing the groups with and without a ferrule Regulatory Statement

effect, some differences in the failure pattern were This study was conducted in accordance with all the
observed (Figure 4). The nonferrule specimen pre- provisions of the local oversight committee guidelines and
sented with an adhesive failure between the crown policies of the Federal University of Santa Maria. The
approval code for this study is 042272.
and root (lingual surface), followed by a crack into
the canal that finished on the buccal root dentin Conflict of Interest
(Figure 4A). In contrast, the ferruled specimen
The authors of this article certify that they have no
presented with the same adhesive failure (crown/ proprietary, financial, or other personal interest of any nature
root) with a crack starting on the prosthetic shoulder or kind in any product, service, and/or company that is

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into the canal (Figure 4B). The presence of the presented in this article.
ferrule between the post and crown created a lever
arm due to the bending movement (Figure 4). (Accepted 27 February 2019)
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