Influence of endodontic treatment, post insertion, and ceramic restoration on the fracture resistance of maxillary premolars

P>Aim To investigate the effects of endodontic treatment, post placement and ceramic restoration type on the fracture resistance of premolars. Methodology One hundred and twenty teeth maxillary premolars were allocated to four groups (A-D; n = 30). In group A, mesio-occlusal-distal-inlays with a buccal and palatal wall of 2 mm (MOD), in group B partial onlays with palatal cusp coverage and in group C total onlays with buccal and palatal cusp coverage were prepared. Group D served as untreated controls. Groups A-C were divided into three subgroups (n = 10): (i) teeth received solely the described preparations, (ii) teeth were root filled, (iii) teeth were root filled and quartz fibre posts were placed. Teeth were restored using Computer-assisted design/computer-assisted machining-ceramic-restorations and subjected to thermo-mechanical-loading; subsequently, the buccal cusp was loaded until fracture. Results Group D revealed significantly higher fracture resistance [mean (standard deviation)] [738 (272) N] compared to all other groups (P < 0.05; post hoc test Dunnett). For groups A-C, fracture resistance was significantly affected by the restoration type (P = 0.043) and endodontic treatment/post placement (P = 0.039; 2-way anova). Group A [380 (146) N] showed significantly lower fracture resistance compared to group B [470 (158) N] (P = 0.048; post hoc test Tukey). Compared to non-endodontically treated teeth [487 (120) N], root filled teeth revealed significantly lower fracture resistance [389 (171) N] (P = 0.031). Conclusion The restoration of cavities with a remaining wall thickness of 2 mm using ceramic MOD-inlays is inferior with respect to the fracture resistance compared to partial onlay restorations. Root filled teeth without post placement show lower fracture resistance compared to non-endodontically treated teeth.