Fracture resistance of endodontically treated teeth without ferrule using a novel H-shaped short post

Objective: To evaluate the fracture resistance and failure types of modified H-designed intradental short retention preparation for computer-aided design/computer-assisted manufacture (CAD/CAM) restorations, in cases where no ferrule is possible. Method and Materials: A combined finite element analysis and in vitro testing was employed. Forty extracted single-rooted premolars were selected and prepared for the following four groups (n = 10 per group): Group A, H-post preparation restored with glass-ceramic crowns; group B, H-post preparation restored with lithium disilicate crowns; group C, endocrowns (negative control group); and group D, 2-mm ferrule preparation and restoration with fiber posts (positive control). After cementation, specimens were loaded to fracture (1 mm/min) in a universal testing machine. The data were analyzed using Kolmogorov-Smirnov, Shapiro-Wilk test, one-way ANOVA, followed by post-hoc Scheffé test and chisquare test. Results: The H-post group restored with lithium disilicate crowns (group B) presented higher fracture resistance compared to the H-post group with glass-ceramic crowns (group A) and the endocrowns (group C). Among the failure analysis, only specimens of group C were all repairable after fracture load test, while the specimens of remaining groups A, B, and D accounted for 90%, 70%, and 50% repairable fracture modes, respectively. Conclusion: The modification of the short intracoronal restoration anchorage profile may be a valid concept to improve the retention and fracture resistance, given that the materials are adjusted for this purpose in terms of mechanical resistance and internal adaptation. Numerical evaluations and future in vitro studies may help to select the best designs and materials. Keywords: bonding, CAD/CAM, ceramic, failure types, finite element analysis, fracture resistance