CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0043-1764421
Original Article

Endocrown Feasibility for Primary Molars: A Finite Element Study

1   Batterjee Medical College, Jeddah, Saudi Arabia
1   Batterjee Medical College, Jeddah, Saudi Arabia
2   Pediatric Dentistry Department, Faculty of Dentistry, Al-Azhar University, Assiut, Egypt
Mohamed AboElkasem Ahmed Wakwak
2   Pediatric Dentistry Department, Faculty of Dentistry, Al-Azhar University, Assiut, Egypt
Wafa Abdullah Bathabt
1   Batterjee Medical College, Jeddah, Saudi Arabia
2   Pediatric Dentistry Department, Faculty of Dentistry, Al-Azhar University, Assiut, Egypt
3   Misr University for Science & Technology (MUST) 6th of October City, Giza, Egypt
› Author Affiliations
Funding None.


Objective To study the possibility of using pediatric endocrowns to restore the second primary molar using three-dimensional (3D) finite element analysis.

Design A 3D finite element model was built for a pediatric mandibular molar, starting with laser scanning a naturally extracted tooth. The access cavity had an elliptic shape with 6 mm width, 4 mm height, and 2 mm depth with a wall taper angle of 5 degrees.

Two materials (Zr and E-max) were tested for the endocrown and two cementing materials (glass ionomer and resin cement) with 20 to 40 μm thickness. Twelve case studies were reported within this research as the applied load of 330 N was tested with three angulations vertical, oblique at 45 degrees, and laterally.

Results Twelve linear static stress analyses were performed. The resultant stresses and deformations' distribution patterns did not alter much, and values were within the threshold of physiological tolerance. Deformations were negligibly changed with changing endocrown and cement materials. In contrast, endocrown stresses indicated zirconia endocrown would have a long lifetime, while E-max one will have a relatively short lifetime.

Conclusions Analysis results indicated that bone was negligibly affected by changing endocrowns and cementing materials. Both tested endocrown materials can be used safely. Zirconia endocrowns may have a much longer lifetime than E-max.

Ethical Approval

This research did not require ethical approval and followed the Helsinki declaration.

Publication History

Article published online:
02 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J 2006; 201 (10) 625-626
  • 2 Sabel N, Johansson C, Kühnisch J. et al. Neonatal lines in the enamel of primary teeth–a morphological and scanning electron microscopic investigation. Arch Oral Biol 2008; 53 (10) 954-963
  • 3 Anderson M. Risk assessment and epidemiology of dental caries: review of the literature. Pediatr Dent 2002; 24 (05) 377-385
  • 4 Yengopal V, Harneker SY, Patel N, Siegfried N. Dental fillings for the treatment of caries in the primary dentition. Cochrane Database Syst Rev 2009; (02) CD004483
  • 5 Full CA, Walker JD, Pinkham JR. Stainless steel crowns for deciduous molars. J Am Dent Assoc 1974; 89 (02) 360-364
  • 6 Sajjanshetty S, Patil PS, Hugar D, Rajkumar K. Pediatric preformed metal crowns - an update. Journal of Dental and Allied Sciences. 2013; 2: 29
  • 7 El Makawi Y, Khattab N. In vitro comparative analysis of fracture resistance of lithium disilicate endocrown and prefabricated zirconium crown in pulpotomized primary molars. Open Access Maced J Med Sci 2019; 7 (23) 4094-4100
  • 8 Clark L, Wells MH, Harris EF, Lou J. Comparison of amount of primary tooth reduction required for anterior and posterior zirconia and stainless-steel crowns. Pediatr Dent 2016; 38 (01) 42-46
  • 9 Bica C, Pescaru P, Stefanescu A. et al. Applicability of zirconia-prefabricated crowns in children with primary dentition. Rev Chim 2017; 68: 1940-1943
  • 10 Rocca GT, Saratti CM, Poncet A, Feilzer AJ, Krejci I. The influence of FRCs reinforcement on marginal adaptation of CAD/CAM composite resin endocrowns after simulated fatigue loading. Odontology 2016; 104 (02) 220-232
  • 11 Guo J, Wang Z, Li X, Sun C, Gao E, Li H. A comparison of the fracture resistances of endodontically treated mandibular premolars restored with endocrowns and glass fiber post-core retained conventional crowns. J Adv Prosthodont 2016; 8 (06) 489-493
  • 12 Raposo LH, Armstrong SR, Maia RR, Qian F, Geraldeli S, Soares CJ. Effect of specimen gripping device, geometry and fixation method on microtensile bond strength, failure mode and stress distribution: laboratory and finite element analyses. Dent Mater 2012; 28 (05) e50-e62
  • 13 Al Qahtani WMS, Yousief SA, El-Anwar MI. Recent advances in material and geometrical modelling in dental applications. Open Access Maced J Med Sci 2018; 6 (06) 1138-1144 DOI: 10.3889/oamjms.2018.254.
  • 14 Sabit A, Mohsen C, El-Anwar M, Metawally M. An in-vitro study of crowned endodontically treated immature permanent central incisor reinforced with different types of aesthetic posts using FEA. IOSR J Dent Med Sci 2017; 16 (08) 82-87
  • 15 Fathy SM, Anwar MIE, Fallal AAE. et al. Three-dimensional finite element analysis of lower molar tooth restored with fully milled and layered zirconia crowns. J Dent Health Oral Disord Ther 2014; 1 (04) 89-95
  • 16 El-Anwar MI, Tamam RA, Fawzy UM, Yousief SA. The effect of luting cement type and thickness on stress distribution in upper premolar implant restored with metal ceramic crowns. Tanta Dental Journal 2015; 12 (01) 48-55
  • 17 Romeed SA, Dunne SM. Stress analysis of different post-luting systems: a three-dimensional finite element analysis. Aust Dent J 2013; 58 (01) 82-88
  • 18 Ha SR, Kim SH, Han JS. et al. The influence of various core designs on stress distribution in the veneered zirconia crown: a finite element analysis study. J Adv Prosthodont 2013; 5 (02) 187-197
  • 19 Waly AS, Souror YR, Yousief SA, Alqahtani WMS, El-Anwar MI. Pediatric stainless-steel crown cementation finite element study. Eur J Dent 2021; 15 (01) 77-83
  • 20 Guelmann M, Shapira J, Silva DR, Fuks AB. Esthetic restorative options for pulpotomized primary molars: a review of literature. J Clin Pediatr Dent 2011; 36 (02) 123-126
  • 21 Dhar V, Hsu KL, Coll JA. et al. Evidence-based update of pediatric dental restorative procedures: dental materials. J Clin Pediatr Dent 2015; 39 (04) 303-310
  • 22 Zhu J, Rong Q, Wang X, Gao X. Influence of remaining tooth structure and restorative material type on stress distribution in endodontically treated maxillary premolars: a finite element analysis. J Prosthet Dent 2017; 117 (05) 646-655
  • 23 Liu C, Eser A, Albrecht T. et al. Strength characterization and lifetime prediction of dental ceramic materials. Dent Mater 2021; 37 (01) 94-105
  • 24 Kamenskikh AA, Sakhabutdinova L, Astashina N, Petrachev A, Nosov Y. Numerical modeling of a new type of prosthetic restoration for non-carious cervical lesions. Materials (Basel) 2022; 15 (15) 5102
  • 25 Djebbar N, Serier B, Bouiadjra BB, Benbarek S, Drai A. Analysis of the effect of load direction on the stress distribution in dental implant. Mater Des 2010; 31 (04) 2097-2101
  • 26 Kamposiora P, Papavasiliou G, Bayne SC, Felton DA. Predictions of cement microfracture under crowns using 3D-FEA. J Prosthodont 2000; 9 (04) 201-209
  • 27 Ha SR. Biomechanical three-dimensional finite element analysis of monolithic zirconia crown with different cement type. J Adv Prosthodont 2015; 7 (06) 475-483
  • 28 Santamaria RM, Innes NPT, Machiulskiene V, Evans DJP, Splieth CH. Caries management strategies for primary molars: 1-yr randomized control trial results. J Dent Res 2014; 93 (11) 1062-1069
  • 29 Dejak B, Młotkowski A. 3D-Finite element analysis of molars restored with endocrowns and posts during masticatory simulation. Dent Mater 2013; 29 (12) e309-e317
  • 30 Seddik T, Derelioglu S. Effect of endocrowns on fracture strength and microleakage of endodontically treated primary molar teeth. Journal of Advanced Oral Research. 2019; 10 (02) 113-119
  • 31 Dursun E, Monnier-Da Costa A, Moussally C. Chairside CAD/CAM composite onlays for the restoration of primary molars. J Clin Pediatr Dent 2018; 42 (05) 349-354
  • 32 Bilgin MS, Erdem A, Tanrıver M. CAD/CAM endocrown fabrication from a polymer-infiltrated ceramic network block for primary molar: a case report. J Clin Pediatr Dent 2016; 40 (04) 264-268