Basic ResearchTechnology

Vertical Root Fracture in Upper Premolars with

Endodontic Posts: Finite Element Analysis
Andrea F.V. Santos,* Carina B. Tanaka,* Raul G. Lima, PhD, Camila O.M. Espsito,*
Rafael Y. Ballester, PhD,* Roberto R. Braga, PhD,* and Josete B.C. Meira, PhD*
Abstract
Upper premolars restored with endodontic posts
present a high incidence of vertical root fracture (VRF).
Two hypotheses were tested: (1) the smaller mesiodistal diameter favors stress concentration in the root and
(2) the lack of an effective bonding between root and
post increases the risk of VRF. Using finite element
analysis, maximum principal stress was analyzed in
3-dimensional intact upper second premolar models.
From the intact models, new models were built including endodontic posts of different elastic modulus (E
37 or E 200 GPa) with circular or oval cross-section,
either bonded or nonbonded to circular or oval crosssection root canals. The first hypothesis was partially
confirmed because the conditions involving nonbonded, low-modulus posts showed lower tensile stress
for oval canals compared to circular canals. Tensile
stress peaks for the nonbonded models were approximately three times higher than for the bonded or
intact models, therefore confirming the second
hypothesis. (J Endod 2009;35:117120)

Key Words
Biomechanics, endodontic posts, endodontically treated
teeth, finite element analysis, root fracture

From the *Department of Dental Materials, School of

Dentistry, University of So Paulo, So Paulo, Brazil; and

Department of Mechanical Engineering, University of So

Paulo, So Paulo, Brazil.
Supported by FAPESP (05/53069-1, 07/00191-0) and CNPq.
Address requests for reprints to Dr Josete Barbosa Cruz
Meira, Department of Dental Materials, School of Dentistry,
University of So Paulo, Av. Prof. Lineu Prestes, 2227 So
Paulo, SP, Brazil 05508-000. E-mail address: jo@usp.br.
0099-2399/$0 - see front matter
Copyright 2008 American Association of Endodontists.
doi:10.1016/j.joen.2008.09.021

he restoration of severely destructed, endodontically treated teeth poses a challenge

to the clinician. The occurrence of vertical root fracture (VRF) is the most critical
failure in teeth restored using endodontic posts. Root fracture usually originates where
tensile stresses reach a critical value, propagating perpendicularly to stress direction
(1). Thus, circumferential tensile stresses around the canal wall are the most deleterious in terms of VRF risk (1, 2). The highest incidence of VRF is found in upper
premolars (35). Because of their small mesiodistal root diameter (2, 4, 6, 7), the
palatal and buccal aspects of the root act as stress concentration sites (1, 2, 8), explaining the fracture path in the buccal-palatal direction despite the higher dentin
thickness in those areas (1, 8, 9).
Theoretic and experimental models used to verify the hypothesis of stress concentration in oval root canals used uniform loads applied perpendicularly to the canal wall
(1, 2, 8, 10), simulating the lateral condensation of gutta-percha during root filling.
However, the occurrence of VRF is more often associated with an inadequate prosthetic
rehabilitation (4, 11). Therefore, there is a demand for models simulating endodontically treated, restored teeth with oval-shaped root canals in order to verify if stress
concentration would also occur under occlusal loading.
The restoration of a severely destructed, endodontically treated tooth requires the
use of an intraradicular post to retain the core, which, in turn, will retain the crown. The
elastic modulus of the post material is a very controversial subject in the literature. Some
authors considered that an excessively stiff post may act as a wedge, increasing the risk
of root fracture (12, 13). However, studies using finite element analysis (FEA) have
shown similar tensile stress in intact and restored teeth regardless of the post elastic
modulus when a perfect adhesion between post and root is considered (14, 15).
Considering that bonding effectiveness at the apical third is questionable (2, 16), the
use of models simulating a perfectly bonded interface to study root fracture may lead to
false conclusions.
This study investigated the hypothesis that the presence of the post increases the
risk of VRF only in cases in which there is debonding between post and root. Fracture
risk would also be increased in cases in which the post cross-section matches the
smaller mesiodistal diameter characteristic of upper premolars because of a moment
effect. Thus, the purpose of the present study was to compare the tensile stresses in
models simulating teeth with oval or circular root canals restored using either bonded
or nonbonded posts with oval or circular cross-section.

Material and Methods

FEA was performed by using MSC.PATRAN (pre- and postprocessing) and MSC.Marc
(processor) software (MSC Software, Santa Ana, CA). Two three-dimensional models of
intact upper second premolars were built, with dimensions drawn from the literature (17,
18) (Fig. 1). To avoid the influence of complex anatomic features, the roots were modeled
with an oval external cross-section in which the buccopalatal depth was twice the mesiodistal
width (ie, eccentricity equals two). Dentin thickness was uniform throughrootlength(2mm).
The root canal shape was oval in one of the models (Io) and circular in the other one (Ic).
From the intact teeth models, new models were built including intraradicular posts
of different elastic modulus (37 and 200 GPa) and same length (two thirds of the root
length). To simulate the endodontic and prosthetic treatments, the pulp chamber was
enlarged by 2 mm and the root canal by 1 mm (19). For the conditions simulating oval
canals (Co), posts could have either oval (Po) or circular cross-sections (Pc). For the

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Figure 1. (A) A three-dimensional model of the intact tooth and (B) a three-dimensional model with endodontic post. Dimensions are in millimeters. E, elastic
modulus; , Poissons ratio.

models with circular canals (Cc), only posts with circular cross-section
were simulated. The eccentricity of the oval canals and posts was constant along their lengths (bucco palatal diameter/mesiodistal diameter2). For conditions in which root canal and post had similar crosssection (CoPo and CcPc), composite resin cement thickness was kept
constant at 0.1 mm, which was not possible for CoPc. Finally, a porcelain-fused-to-metal crown with a 1.5-mm ferule was also included in the
models. All materials were considered homogeneous, linear elastic, and
isotropic. Elastic modulus and Poissons ratio are presented in Figure 1.
Regarding the post/dentin interface, two conditions were simulated: ideally bonded (B) or nonbonded (nB). For the nonbonded models, a touch contact mode was chosen in which dentin nodes can slide or
separate from the cement nodes but they cannot interpenetrate. Nodes located at the upper and lateral portions of the trabecular bone were con-

strained in the six degrees of freedom. A 300-N load was applied on the
internal surface of the buccal cusp at 45o with the long axis of the tooth
(producing deflection toward the buccal direction) and deviated toward
mesial (producing deflection towards the distal direction). Models had
between 45,340 and 93,201 tetraedrical elements (tet4).
Because tensile stresses are more closely associated to dentin
fracture (1, 20), models were compared regarding max distribution
(maximum principal stress) in dentin as well as magnitude, location,
and direction of the maximum max vector.

Results
Figure 2 presents maximum tensile values, locations, and directions, whereas Figure 3 shows max distribution in the dentin of intact

Figure 2. Magnitude, locations, and directions of maximum tensile stress. Ic and Io, circular and oval canal intact teeth; Cc and Co, circular and oval canal; Pc and
Po, circular and oval posts; B and nB, bonded and nonbonded post; 37 and 200, post elastic modulus of 37 GPa and 200 GPa. Default view indicates the model position.

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Figure 3. Maximum principal stress distribution. Ic and Io, circular and oval canal intact teeth; Cc and Co, circular and oval canal; Pc and Po, circular and oval posts;
B and nB, bonded and nonbonded post; 37 and 200, post elastic modulus of 37 GPa and 200 GPa; p and b, palatal and buccal aspects. White areas indicate compressive
stress (negative values of max), and colored areas indicate tensile stress (positive values of max).

and restored teeth. Tensile stress peak in models with nonbonded posts
was approximately three times higher than for the models of intact teeth
and those with bonded posts. Evident differences in max magnitude
were present between circular and oval nonbonded posts, with the latter
displaying lower stresses. For the models with bonded posts, differences
were small and stress values were similar to those verified for the intact
teeth. Maintaining the other variables constant, max decreases with the
increase of post elastic modulus and when root canal cross-section
changed from oval to circular.

Discussion
The hypothesis that stress concentrates in buccal and palatal aspects of endodontically treated, prosthetically restored upper premolars under functional loading was partially confirmed. In fact, for teeth
restored with nonbonded circular posts (CoPcnB and CcPcnB), reductions in max (27% for E 37 GPa, 46% for E 200 GPa) were
observed between oval and circular canal cross-sections (Fig. 2). Also,
for CoPcnB200, max was located in the buccal aspect, whereas for
CcPcnB200 it was deviated toward the proximal. However, when both
post and canal cross-section varied simultaneously (ie, CcPc vs CoPo),
the interplay among variables was more complex, and the hypothesis
could not be confirmed. For nonbonded, low-modulus posts as well as
for bonded, high-modulus posts, the stress response was the opposite of
the initial hypothesis because the models with oval posts and canals
showed lower stress in the root compared with those with circular
cross-sections.

JOE Volume 35, Number 1, January 2009

The second hypothesis, that the risk of root fracture is higher in the
absence of bonding between post and dentin, was confirmed. The maximum principal stress in dentin was three times higher in nonbonded
conditions compared with models in which an ideal bonding between
post and dentin was simulated. Bonding ensures that the post, crown,
and root work together, granting stress level and distribution similar to
those observed in the intact teeth (Fig. 3). This finding agrees with those
from a study by DArcangelo et al. (21) in which similar fracture
strength values were reported for intact teeth and those restored using
fiber-reinforced bonded posts. In this case, the tooth fixed to the alveolar socket behaves like a cantilever beam, with tensile stresses situated
in the palatal aspect and compressive stresses in the buccal aspect. The
maximum tensile was much lower than the dentin tensile strength (185
MPa) (22), and its location and direction are not compatible to VRF
patterns reported in the literature (23). These findings agree with those
of previous studies (24, 25) ratifying the need for high bond strengths
between post and dentin.
However, the establishment of a strong and long-lasting adhesion
to radicular dentin remains a challenge, particularly in the apical third
(2, 16). When a nonbonded post is under functional loading, a gap is
formed between the cement underneath the crown and the palatal dentin. As a consequence, the high tensile stresses in the palatal aspect are
eliminated (Fig. 3), and the crown is given more freedom to move
buccally. Considering an ideal union between the post and crown, when
the latter is forced toward the buccal aspect, the post generates two high
stress concentration sites: the cervical region on the buccal aspect and

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the apical area on the palatal aspect. In most cases, the maximum tensile
occurred at the cervical-buccal region, parallel to the transversal plane
and circumferential to the root curvature (Fig. 2). The exception was
the high-modulus oval post, where maximum tensile stresses were located at the apical palatal, also circumferential to root curvature, but
oblique to the transversal plane. Both stress patterns are compatible to
VRF in the buccopalatal direction.
Regarding post cross-section, it was expected that the nonbonded
oval post placed in the oval canal would cause an effect similar to a
screwdriver turned inside the root and that such moment effect would
increase the risk of VRF. However, the results indicated the very opposite, probably because oval posts were thicker in the buccal-palatal
dimension and, therefore, more rigid than the circular posts. Because
stiffer posts impose more resistance to flexional or rotational forces
(26), it is likely that oval posts deflected less to the buccal direction and
rotated less around the longitudinal axis, causing less stress on the
cervical-buccal and apical-palatal areas of the root. The same explanation is valid for the influence of post elastic modulus. For a given geometry, the higher the elastic modulus, the higher the post stiffness and the
lower the stress on the root; this is in agreement with previous findings
(25, 2729).
The use of low-modulus, glass fiber posts is becoming increasingly
popular because of the reduced the clinical time and risk of canal
contamination by post placement in the same appointment. The results
of the present study, however, revealed that from a biomechanical
standpoint, the low elastic modulus and the circular cross-section of
glass fiber posts do not present any advantage compared with cast posts.
Data available in the literature indicating a better performance with
these materials are probably the result of the use of adhesive cementation. Because the longevity of bonding procedures involving radicular
dentin are uncertain, a long-term clinical follow-up is necessary to
confirm the effectiveness of glass fiber posts as a restorative solution for
endodontically treated teeth.
Finally, the results of the present study showed that the smaller
mesiodistal root diameter in upper second premolars does not seem to
be a main determinant for VRF susceptibility. It is likely that irregularities of the external curvature and the difficulty of using posts with the
recommended length (two thirds of root length) are more important
(30, 31). Although such factors are often associated with upper premolars, they were not included in this study. The study of stress distribution
in restored roots is quite complex because of the influence of a large
number of variables. In the present study, some simplifications were
made in order to isolate the variables (post elastic modulus and bonding conditions and post and canal geometries). These simplifications
included keeping a uniform thickness of the root wall through its length
to avoid stress concentration in the thinner sections. In future investigations, it is intended to gradually increase the complexity of the FEA
model, including variations in dentin thickness and introducing anatomic irregularities in order to assess their influence on VRF.

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