Fracture resistance and reinforcement of immature roots with gutta percha, mineral trioxide aggregate and calcium phosphate bone cement: a standardized in vitro model

Endodontic treatment of immature teeth is often complicated because of flaring root canals and open apices for which apexification is needed. Long-term prognosis for these teeth is surprisingly low because of cervical root fractures occurring after an impact of weak forces. In this study, an experimental model was developed to determine the fracture resistance of immature teeth and to test the hypothesis that endodontic materials succeed in reinforcing them. Compact and hollow bone cylinders from bovine femurs were used as standardized samples. In order to evaluate the experimental model, fracture resistance in both groups was evaluated by determining the ultimate force to fracture (UFF) under diametral tensile stress. Analysis of variance (ANOVA) revealed a statistically significant difference between the mean values of UFF for both groups, independently of the sampling location or subject. In a following setting, the hypothesis that obturation with gutta percha (GP), mineral trioxide aggregate (MTA), or calcium phosphate bone cement (CPBC) reinforces the hollow bone samples was investigated. Obturation resulted in a significant reinforcement for all materials, but the degree of reinforcement depended on the material. The experimental model appeared to be suitable for in vitro investigation of reinforcement and fracture resistance in a standardized way