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Journal of Oral Rehabilitation 2002 29; 28±34

Effect of length and diameter of tapered posts


on the retention
_ N E R G IZ
I. _ *, P. SCHMAGE*, M. O
È ZCAN² & U. PLATZER* *Department of Operative Dentistry and
²
Periodontology, Dental School, University of Hamburg, Hamburg, Germany and Department of Prosthodontics, Dentistry Faculty, Marmara
_
University, Istanbul, Turkey

SUMMARY The force transmission of tapered portional to the length as well as to the diameter of
unthreaded posts along the root has been reported the posts. The mean minimum strength (181 ‹ 14 N)
to be homogenous but their retentive strength was recorded for the thinnest and shortest post was
found to be lower compared with those of parallel signi®cantly lower than that of mean maximum
unthreaded or other kinds of threaded posts. The strength (612 ‹ 85 N) obtained from those of the
purpose of this in vitro study was to investigate the thickest and longest post. Proportional bond stren-
effect of length and diameter on the retentive gths of the posts comprising their surface areas
strength of sandblasted tapered prefabricated tita- ranged between 6á8 and 7á9 N mm±2 which were
nium posts (Erlangen post systemÒ). Posts with not signi®cantly different between any group. The
constant taper angle but with three different retention was effected strongly with the increase in
lengths (9, 12, 15 mm) and apical diameters (0á5, the length (approximately 100%) than with the
0á9, 1á1 mm) were cemented using zinc phosphate increase in the diameter (approximately 60%). Con-
cement into the prepared and roughened post cerning the posts tested in this study, it is concluded
spaces of 90 intact anterior teeth. The post retention that some caution should be exercised in the choice
concerning length and diameter, being independent of post with appropriate length rather than diam-
from each other, was measured by a tensile force eter for the tooth concerned.
test. The retentive strength was found to be pro- KEYWORDS : prefabricated post, post size, retention

Maximum retentive strength is necessary to obtain a


Introduction
permanent anchorage between post and post space. The
The advantages of prefabricated posts for the restor- long-term clinical service of prefabricated posts depends
ation of the teeth with missing coronal structure are on a number of independent factors of which design,
well documented. In the long term clinical success, surface texture, diameter and length are signi®cant
physical and mechanical factors in¯uencing the parameters (Newburg & Pameijer, 1976; Johnson &
retentive properties of the posts are important (Caputo Sakumura, 1978; Standlee et al., 1978; Ruemping et al.,
& Standlee, 1976; Wood, 1983; Hudis & Goldstein, 1979; Cooney et al., 1986; Hudis & Goldstein, 1986;
1986; Nathanson & Ashayeri, 1990; Morgano, 1996; Lewis & Smith, 1988; Lloyd & Palik, 1993; Nergiz et al.,
Zuckerman, 1996). Prefabricated posts are advanta- 1997). Such factors in¯uence the strength of the post
geous in cases where not too much coronal tooth itself and the resistance of the root could be avoided. In
structure is missing. The use of such posts are addition, a homogenous stress transmission of occlusal
popular because of their form-congruence between forces along the root is requested (Assif et al., 1989;
the post space and the post itself as well as less Holmes et al., 1996). Unthreaded tapered posts are
chair-side requirements (Christensen, 1993; Morgano usually preferred because of their conformance with
et al., 1994). the natural root form avoiding stress peaks (Sorensen

ã 2002 Blackwell Science Ltd 28


EFFECT OF POST SIZES ON THEIR RETENTION 29

et al., 1978; Davy et al., 1981; Assif et al., 1993)


although it is known that such posts have lower
retentive strengths compared with parallel unthreaded
or other kinds of threaded posts (Johnson & Sakumura,
1978; Ruemping et al., 1979; Cooney et al., 1986; Hudis
& Goldstein, 1986; Ricker et al., 1986; Brown &
Mitchem, 1987).
The choice of the posts are pre-destined to the
dimension of the root canal and limited by the size of
the root. Several authors have made recommendations
about choosing the correct post for endodontically
treated tooth (Caputo & Standlee, 1976; Hudis &
Goldstein, 1986; Lewis & Smith, 1988; Nathanson &
Ashayeri, 1990; Morgano, 1996). It is claimed that
the use of a longer rather than a thicker diameter
post in¯uences the retentive strength positively
(Schillingburg et al., 1970; Standlee et al., 1978; Trabert
et al., 1978; Hudis & Goldstein, 1986; Nathanson &
Ashayeri, 1990). Therefore, the knowledge about the
factors in¯uencing the relatively low retentive proper-
ties of tapered posts become even more important and
the need for clari®cation of the effect of post diameter
and length remains open to question as different
opinions still exists relating to retention.
The objective of the present in vitro investigation was
mainly to verify the effect of different lengths and
diameters on the retentive strength of tapered posts.

Fig. 1. Nine groups of Erlangen post systemÒ varying in length


Materials and methods
and diameter.

Posts
Tooth preparation
Ninety prefabricated tapered titanium prototype posts
of the Erlangen post systemÒ* with retentive heads The study was performed with 90 recently extracted
were investigated. Posts of three sizes: post no. 1 single-rooted human anterior teeth without caries that
(0á5 mm base diameter), post no. 2 (0á9 mm base were stored in physiologic saline solution until use.
diameter), post no. 3 (1á1 mm base diameter) and three After cleaning the teeth surfaces from debris, each
different lengths (9, 12, 15 mm) were used. Through clinical crown was removed perpendicular to the long
the combination of length and diameter, nine groups axis of the tooth by a band saw³ and the direction of
each having 10 specimens were formed (Fig. 1). All of each root canal was inspected. Care was taken that for
the posts had surfaces with 2á1° angle of divergence. each group of posts, the teeth with the corresponding
The post surfaces were sandblasted and the mean length and adequate root canal diameter were chosen.
value of surface roughness Ra (éilo & Jùrgensen, 1978) Three experimental groups, consisting of 30 roots each,
amounted to approximately 12á9 lm. This value was were endodontically treated up to the ISO-®le sizes of
determined by the manufacturer with a surface pro®le 045, 080, 100, respectively. When the endodontic
measuring instrument (Model S8P Perthometer²). treatments were completed, post spaces were prepared
with the use of the post drills corresponding to the three
*Brasseler USA, Savannah, GA, USA; Komet GmbH, Lemgo, Germany.
² ³
Mahr GmbH, GoÈttingen, Germany. EXACT, Norderstedt, Germany.

ã 2002 Blackwell Science Ltd, Journal of Oral Rehabilitation 29; 28±34


30 _ N E R G I_ Z et al.
I.

Table 1. Surface areas of the posts in mm2

Post length (mm)

Post size 9 12 15

No. 1 22á9 34á1 47á9


No. 2 33á7 49á2 66á7
No. 3 39á6 56á9 77á8

40±50 N was maintained for 10 min until the cement


had set. Standardization of the 40±50 N ®nger pressure
was practiced on a scale, both before and during the
Fig. 2. Hand-held post preparation drills in three sizes and the
cementation process and all of the posts were cemented
corresponding diamond-coated canal-wall roughening drills of the
Erlangen post systemÒ.
by the same person. In order to prevent dehydration,
the teeth were wrapped in a physiologic saline soaked
towel and stored in a closed container at 37 °C for 24 h
sizes of the posts* (Fig. 2). Post spaces were created as until the tensile force test.
deep as possible for each post length, using a distance
tube with the post drill as recommended by the
manufacturer. Thirty roots were prepared having 10 Tensile force test
roots for each post group with 9, 12 and 15 mm lengths A modi®ed tensile force measuring instrument (Model
in the same manner. 1026**) was used to apply force along the long axis of
Additionally, all post spaces were roughened with a the post and the tooth at a crosshead speed of
hand-held diamond-coated drill of the same size and 1 mm min±1. The force required to dislodge each post
shape as the post preparation drill, by rotating it ®ve was then recorded. The retentive strength was de®ned
times (diamond instrument, Erlangen post systemÒ, as the tensile force necessary to separate the post from
mean surface roughness Ra ˆ 52 lm)* (Fig. 2). The the prepared post space. The proportional bonding
surface roughness of the post space after use of the strength (N mm±2) calculated for each group was
diamond bur was approximately Ra ˆ 21 lm. This de®ned as the retentive strength (N) per unit surface
value was obtained by cutting another set of teeth area of the post (mm2). The differences in surface area
after being prepared into half vertically using the band between the post groups with different dimensions but
saw and measuring the roughness of the post space as of same shapes had been taken into consideration. The
described previously (éilo & Jùrgensen, 1978). surface areas referring to each post as provided by the
Before cementation, the post spaces were irrigated manufacturer are summarized in Table 1.
with 1á5% sodium hypochloride intensively and dried
with paper points§ thoroughly. For the purpose of
cementation, a standard zinc phosphate cement Statistical analysis
(TenetÒ¶) was used. The cement was prepared always The data obtained were analysed by the package
by the same investigator on a cooled (6 °C) glass mixing program SPSS/PC+ (Version 7á0). Statistical evaluation
slab at a constant room temperature of 20 °C, according was carried out using Mann±Whitney U-test corrected
to the manufacturer's directions. Powder was added to with the Boneferroni method because of the signi®cance
the liquid in small increments and mixed thoroughly by levels. Comparisons were made between all groups in
using the majority of the mixing slab to arrive at a order to assess the effects of length and diameter of the
creamy consistency where a small portion of the mix posts referring the retentive strength and the propor-
did not drop from the spatula. The posts were lightly tional bond strength. A P-value of 0á05 or less was
coated with cement and seated into the prepared post considered as statistically low signi®cant and P-value of
spaces. Constant ®nger pressure of approximately 0á001 or less as high signi®cant. Percentage retention
§
Roeko, Langenau, Germany.

Vivadent, Inc., Amherst, NY, USA. **Instron Corp., Los Alimitos, CA, USA.

ã 2002 Blackwell Science Ltd, Journal of Oral Rehabilitation 29; 28±34


EFFECT OF POST SIZES ON THEIR RETENTION 31

increases were calculated between a shorter and a longer


post if the size parameter stayed constant. The percent-
age retention rates caused by the increase in diameter
(%) were also calculated for constant post lengths.

Results
Retentive strengths of cemented tapered posts increased
proportional by the increase in length and diameter.
Posts with size 1 and 9 mm length exhibited the lowest
mean tensile strength with 181 ‹ 14 N, whereas size 3,
length 15 mm demonstrated an absolute maximum
retentive strength value with 612 ‹ 85 N. The resulting
mean retentive strength values and standard deviations
are presented in Fig. 3a and b. Comparison between all
groups were statistically different except between the
post groups of size 2 and 3 with 12 mm length.
However, no or low signi®cant differences were
found between the groups when the proportional
bonding strength were calculated (Fig. 4a and b). The
values varied between 6á8 and 7á9 N mm±2.
The rate of increase in strength amounted to
approximately 100% referring to the length and
approximately 60% to the diameter (Table 2). A longer
post presented to increase the retentive strength more
than the increase in diameter.
After the tensile test, the Erlangen postsÒ removed
from the roughened post space showed cement adher-
ing to both the posts and the dentin walls of the roots.

Fig. 3. (a) Results of the mean retentive strengths (in N) of


Discussion Erlangen postsÒ with different lengths of the same size. The
median values as well as the standard deviation and the quartile
For the long-term clinical success, the most critical task are given. Signi®cant differences are indicated by *low signi®cant
is to choose the correct post for each endodontically (P < 0á05), **signi®cant (P < 0á01) and ***high signi®cant
treated tooth which can resist the occlusal forces (P < 0á001). (b) Effect of different diameters of posts of the same
without failure such as root fracture, structural failure length on the retentive strengths in N.
of the post itself or loss of retention (Sorensen et al.,
1978; Trabert et al., 1978; Sorensen & Martinoff, 1984b; Although great number of studies have been per-
Hudis & Goldstein, 1986; Lewis & Smith, 1988; Morgano formed, con¯icting results still exists leading to different
& Milot, 1993; TorbjoÈrner et al., 1995). The desired post guidelines in the literature (Sorensen et al., 1978; Stand-
is often determined by the root morphology and the lee et al., 1978; Ruemping et al., 1979; Davy et al., 1981;
sound tooth structure without removing unnecessary Cooney et al., 1986; Hudis & Goldstein, 1986; Christen-
dentin thereby weakening the root. The strength of an sen, 1993; Lloyd & Palik, 1993). Besides the parameters
endodontically treated tooth can be directly related to of length and diameter, retention of a post also depends
the bulk of its remaining dentin (Sorensen & Martinoff, on its design, texture of the post surface as well as on the
1984a; Tjan & Whang, 1985; Trope et al., 1985; Robbins, cementation (Hanson & Caputo, 1974; Newburg &
1990; Morgano, 1996). Post space preparation should Pameijer, 1976; Johnson & Sakumura, 1978; Ruemping
offer adequate retention for a successful post insertion et al., 1979; Cooney et al., 1986; Hudis & Goldstein, 1986;
which necessiates a long and wide canal. Lewis & Smith, 1988; Nathanson & Ashayeri, 1990).

ã 2002 Blackwell Science Ltd, Journal of Oral Rehabilitation 29; 28±34


32 _ N E R G I_ Z et al.
I.

Table 2. The percentage increase showing the enhancement of


retentive strength in increased length or size while the other
parameters stayed constant

Parameter Percentage increase

Post length (mm)


9 100
12 109
15 111

Post size
No. 1 54
No. 2 69
No. 3 63

cases where too much tooth structure was destroyed,


no prefabricated posts should be chosen.
The retentive strength of unthreaded, tapered posts is
well known to be inferior to that of parallel or any other
kind of threaded posts (Hudis & Goldstein, 1986; Ricker
et al., 1986; TorbjoÈrner et al., 1995). However, previous
research on tapered post systems showed adequate
retention for clinical use (Brown & Mitchem, 1987;
Weine et al., 1991; Morgano, 1996; Zuckerman, 1996).
Their small constant angle of divergence should have a
similar effect with the conicity of crowns to achieve
friction. The result of similar proportional bonding
strengths was expected because of the congruent post
form. The retentive strengths of tapered posts were
found to be at least twice more by sandblasting the post
surfaces and roughening the root canal walls when the
Fig. 4. (a) Proportional bonding strengths (in N mm±2) of Erlangen post systemÒ was used (Colley et al., 1968;
respective Erlangen postsÒ with different lengths but same size. éilo & Jùrgensen, 1978; Wood, 1983; Brown & Mit-
Signi®cant differences are indicated by *low signi®cant (P < 0á05), chem, 1987; Weine et al., 1991; Nergiz et al., 1997). For
**signi®cant (P < 0á01) and ***high signi®cant (P < 0á001). (b) The
this reason, prefabricated posts with already sandblasted
in¯uence of increase in diameter on the proportional bonding
strengths (in N mm±2) of Erlangen postsÒ with constant length. surfaces were used for the experiments because of the
advantage of microretention. In this study, the rough-
ened root canal walls allowed the cement retention
The risk of root fracture caused by the investigated through the undercuts. Therefore, an adhered cement
tapered unthreaded posts is very low as a result of their layer was found both at the canal walls and the post
homogenous stress transmission along the root and itself. Previous investigations showed less dislodgement
their shape being congruent to the root form (Assif of the posts because of smooth post and root canal
et al., 1989, 1993; Holmes et al., 1996; Morgano, 1996). surfaces (Sorensen et al., 1978; Christensen, 1993). The
The possibility of root fracture is more if the post space obtained results could be also valid for other passive
preparation is overdimensioned. Choosing a dowel tapered post systems and this needs further research.
large in diameter and long in length results in weak- No cement has demonstrated clear advantages over
ening of the root apically and coronally which decrea- the others for post cementation (Hanson & Caputo,
ses the prognosis (Trabert et al., 1978; Sorensen & 1974; Standleen et al., 1978; Krupp et al., 1979;
Martinoff, 1984b; Robbins, 1990; Morgano, 1996). Nathanson & Ashayeri, 1990). The reason why zinc
Thus, it would be more appropriate to state that in phosphate cement was used in this study is that it is the

ã 2002 Blackwell Science Ltd, Journal of Oral Rehabilitation 29; 28±34


EFFECT OF POST SIZES ON THEIR RETENTION 33

oldest of the cementation agents with the longest track estimate the retention of posts (Hanson & Caputo, 1974;
record (Gorodovsky & Zidan, 1992; Morgano et al., Johnson & Sakumura, 1978; Standlee et al., 1978;
1994). The type of cohesive failure observed after the Krupp et al., 1979; Tjan & Whang, 1985; Trope et al.,
tensile test proves once more that it adheres both on the 1985; Cooney et al., 1986). Other test methods could be
post and the dentin. tried in the future to approve the ®ndings of this study.
A post with too small diameter could bend the most
especially at its coronal end under occlusal stress (Davy
Conclusions
et al., 1981). Bending property of the investigated pre-
fabricated titanium posts has been previously reported to (i) The retentive strength of the posts is affected
be suf®cient (Sorensen et al., 1978; Christensen, 1993). proportionally by the length as well as the diameter of
Previous studies con®rmed that post dislodgement the investigated tapered posts.
was mainly because of too short posts (Morgano & (ii) The proportional bonding strength of the posts
Milot, 1993). Nevertheless, the ferrule effect of the referring to their surfaces revealed to be constant for all
restorative crown relates to the retentive properties of groups.
the post because it in¯uences the post to resist against (iii) The percentage increase in strength amounted to
stress (Sorensen & Martinoff, 1984a; Morgano, 1996). 100% referring to the length and 60% referring to the
The importance of post length has been emphasized in diameter. The choice of an adequate post length was
clinical studies (Hudis & Goldstein, 1986; Lewis & found to be more important than the diameter to obtain
Smith, 1988; Morgano & Milot, 1993). The results high retentive strength.
correlated with the guidelines indicated that the post
length should be as long as the clinical crown. The
Acknowledgments
optimum post length is advised to be two-thirds of the
tooth whereas the crown one third. The success rate The authors gratefully acknowledge the contribution
was recorded to be more than 97% for such cases of the Erlangen post systemÒ by Brasseler, Lemgo,
(Sorensen & Martinoff, 1984b; Sorensen et al., 1978). Germany for this study.
In the literature it has been stated that the in¯uence
of the length factor on the retention of posts was greater
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ã 2002 Blackwell Science Ltd, Journal of Oral Rehabilitation 29; 28±34

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