In vitro comparison of intact endodontically treated teeth with and without endo-post reinforcement

Effect of core stiffness on the in vitro fracture of crowned, endodontically treated teeth

STATEMENT OF PROBLEM

Dentin and core materials that substitute for missing dentin are dissimilar materials. A core material with a lower elastic modulus may deform more under applied stress and therefore result in reduced stress concentration at the core/dentin junction.

PURPOSE

This in vitro study examined the effect of core stiffness on the fracture resistance and failure characteristics of a crowned, endodontically treated tooth under simulated occlusal load.

MATERIAL AND METHODS

Forty extracted human mandibular premolars were divided equally into 4 groups and prepared for posts and cast crowns as follows: group 1 = cast post and core, cast crown; group 2 = preformed metal post, composite core, and cast crown; group 3 = preformed metal post, amalgam core, and cast crown; and group 4 (control) = preformed metal post, no core, and cast crown. All prepared teeth had 2 mm of sound dentin on which the cemented crown rested. A continuous load (kg) was applied to the buccal cusp at a 30-degree angle to the long axis of each tooth at a crosshead speed of 2 mm/min until failure. Collected data were subjected to 1-way analysis of variance with the Welch modification to compare groups (P<.05).

RESULTS

Failure loads for the 4 test groups were as follows: 98.1 +/- 34.6 kg (group 1), 94.4 +/- 41.8 kg (group 2), 105.5 +/- 18.6 kg (group 3), and 101.1 +/- 55.3 kg (group 4). No significant difference in failure load values was found among the 4 groups. The primary mode of failure (80%) in all groups was an oblique radicular fracture, either apical to the post or at the post level. Horizontal fracture of the root and post was found in groups 1, 2, and 3 (20%). Loosening of the crown, post, and core was found only in group 2(20%).

CONCLUSION

Within the limitations of this study, core stiffness did not affect the failure resistance of teeth restored with posts and cores and complete-coverage cast metal crowns. The dominant pattern of failure was unrepairable root fracture. Only the composite core exhibited repairable fractures.

A study on the thickness of radicular dentine and cementum in anterior and premolar teeth

AIM

This study aimed to measure the thickness of radicular dentine and cementum in incisors, canines and premolars, and to develop geometric average models.

METHODOLOGY

The roots of 220 extracted human teeth were sectioned in three horizontal parallel planes and measured using an optical microscope. For each cut surface buccal, lingual, mesial, and distal thickness of the root wall was measured. Mean values of the thickness at each location of each cut surface were calculated. The observed differences in thickness by tooth type, location, and section were compared by ANOVA and Student's t-test.

RESULTS

Maxillary central incisors and maxillary canines had the greatest widths. In all teeth with a single root, the wall thickness were greater on the lingual side than the buccal side. Although differences between mesial and distal thicknesses were not statistically significant.

CONCLUSIONS

Wall thickness varied greatly. The lingual surfaces of roots were larger. All roots had thin walls in the apical third.

Photomechanical investigations on post endodontically rehabilitated teeth

An investigation of the stress distribution patterns in post-core restored teeth and the behavior of dentin material to fracture propagation was conducted using experimental techniques such as digital photoelasticity (on photoelastic models), mechanical testing and scanning electron microscopy (SEM) (on extracted teeth). Digital photoelastic experiments showed that endodontic post-core restoration resulted in regions of high tensile stress and of stress concentrations in the remaining dentin structure. It was observed from mechanical testing that the fracture resistance in post-core restored teeth is significantly lower (p<0.0001) than that in intact tooth. There was a significant correspondence between the plane of stress concentrations identified in the photoelastic models and in those of the plane of fracture exhibited by the rehabilitated tooth specimens. While the fracture of post-core rehabilitated teeth was consistent, that of control teeth was not as distinct. The SEM highlighted varying dentin response to fracture propagation at the inner core and the outer regions. The fractographs showed brittle and ductile response to fracture propagation in the outer and inner core dentin, respectively. These photomechanical studies highlighted that the stress concentrations, high tensile stress and loss of inner ductile dentin associated with post endodontic rehabilitation diminished their resistance to fracture.

Resistance to fracture of endodontically treated teeth restored with different post systems

STATEMENT OF PROBLEM

Very little is known about the resistance to fracture of endodontically treated teeth restored with newly developed esthetic post systems. Purpose. This in vitro study compared the effect of 1 titanium and 3 esthetic post systems on the fracture resistance and fracture patterns of crowned, endodontically treated teeth.

MATERIAL AND METHODS

A total of 40 recently extracted human maxillary canines with their crowns removed were endodontically treated. Four groups of 10 specimens were formed. Teeth were restored with titanium, quartz fiber, glass fiber, and zirconia posts and numbered as groups 1, 2, 3, and 4, respectively. All posts were cemented with Single Bond dental adhesive system and dual-polymerizing RelyX ARC adhesive resin cement. All teeth were restored with composite cores, and metal crowns were fabricated and cemented with glass ionomer cement. Each specimen was embedded in acrylic resin and then secured in a universal load-testing machine. A compressive load was applied at a 130-degree angle to the long axis of the tooth until fracture, at a crosshead speed of 1 mm/min. One-way analysis of variance and a Tukey test were used to determine the significance of the failure loads between groups (P<.001). A non-parametric chi(2) test was conducted for evaluation of the mode of failure (P<.001).

RESULTS

The mean failure loads (kg) were 66.95, 91.20, 75.90, and 78.91 for groups 1 to 4, respectively. Teeth restored with quartz fiber posts (group 2) exhibited significantly higher resistance to fracture (P<.001) than the other 3 groups. Teeth restored with glass fiber and zirconia posts (groups 3 and 4) were statistically similar (P>.05). Fractures that would allow repair of the tooth were observed in groups 2 and 3, whereas unrestorable, catastrophic fractures were observed in groups 1 and 4 (P<.001).

CONCLUSION

Within the limitations of this study, significantly higher failure loads were recorded for root canal treated teeth restored with quartz fiber posts. Fractures that would allow repeated repair were observed in teeth restored with quartz fiber and glass fiber posts.

Restoration of the endodontically treated tooth

It has been the purpose of this article to provide a rationale for the restoration of endodontically treated teeth. Treatment recommendations have been made in the areas of post design, placement technique, cements, core materials, and definitive restorations, based on a review of the clinical and laboratory data.

Vertical root fracture in endodontically treated teeth: a review of 25 cases

OBJECTIVE

We sought to examine the clinical conditions under which 25 endodontically treated teeth underwent vertical root fracture (VRF) and to relate this condition to the time elapsed from endodontic treatment to fracture.

STUDY DESIGN

This was a retrospective study in which we reviewed 25 case histories of patients with postendodontic VRF and studied the effect of various pretreatment and posttreatment factors as they related to VRF.

RESULTS AND CONCLUSIONS

The mean time to VRF was 54 months; this was not significantly influenced by the presence or absence of prior restoration or by the presence or absence of a crown fitting. The use of a prefabricated, cylindrical, cemented intraradicular retainer increased the time between endodontics and VRF. Teeth restored with conventional amalgam took significantly longer to undergo VRF than those restored with composite or bonded amalgam. In contrast, amalgam-restored teeth suffered more coronal fractures before VRF than did teeth in the other 2 groups.

The use of reinforced composite resin cement as compensation for reduced post length

STATEMENT OF PROBLEM

Cements that yield high retentive values are believed to allow use of shorter posts.

PURPOSE

This study investigated the use of reinforced composite resin cement as compensation for reduced dowel length.

MATERIAL AND METHODS

The retention values of stainless steel posts (parallel-sided ParaPost and tapered Dentatus in 5-, 8-, and 10-mm lengths) luted with Flexi-Flow titanium-reinforced composite resin and zinc phosphate cements were evaluated. Single-rooted extracted human teeth with crowns (n = 120), removed at the cementoenamel junction, were randomly divided into 4 groups of 30 samples each. Different post lengths were luted with either Flexi-Flow or zinc phosphate. Each sample was placed into a specialized jig and on a tensile testing machine with a crosshead speed of 2 mm/min, applied until failure. The effect of different posts and cements on the force required to dislodge the dowels was evaluated with multiple analyses of variance (ANOVA). One-way ANOVA with Scheffé contrast was applied to determine the effect of different post lengths on the retentive failure of posts luted with the 2 agents.

RESULTS

Flexi-Flow reinforced composite resin cement significantly increased retention of ParaPost and Dentatus dowels (P<.001) compared with zinc phosphate. One-way ANOVA revealed no statistically significant difference (P>.05) between mean retention of both dowels luted with Flexi-Flow for all posts length used (5 mm = 8 mm = 10 mm). Mean retention values of the groups luted with zinc phosphate showed a statistically significant difference (P<.001) for the different post lengths (10 > 8 > 5 mm). Parallel-sided ParaPost dowels demonstrated a higher mean retention than tapered Dentatus dowels (P<.001).

CONCLUSION

In this study, Flexi-Flow reinforced composite resin cement compensated for the reduced length of shorter parallel-sided ParaPost and tapered Dentatus dowels.

Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study

OBJECTIVES

This study compared the fracture strength and survival rate of endodontically treated crowned maxillary incisors with approximal class III cavities and different core build-ups.

METHODS

Sixty-four caries free human maxillary central incisors were selected for standardized size and quality, endodontically treated and prepared with approximal cavities 3mm in diameter. Group 1 was restored with titanium posts, group 2 received zirconia posts, in group 3 the root canal was partially filled with a hybrid composite. In the control group, only the access opening was restored. All teeth were prepared for and restored with full cast metal alloy crowns and subsequently exposed to 1.2 million cycles in a computer-controlled chewing simulator with simultaneous thermocycling. In addition, the samples were loaded until fracture in a static testing device.

RESULTS

One specimen with composite reinforced root canal did not survive the dynamic load test. The following median fracture strengths in Newtons for the different groups were: titanium post 1038, zirconia 1057, composite resin 750, control (no post) 1171. The fracture load in group 3 (composite resin) was significantly lower (P<0.05) than in the other groups.

CONCLUSIONS

The reconstruction of endodontically treated single rooted teeth with approximal cavities can be successfully performed by closure of the endodontic and additional cavities with composite. Cementation of endodontic posts offers comparable but no advantageous fracture resistance. Enlargement of the root canal space after completion of endodontic treatment should be avoided and cannot be compensated for by injection of composite resin. Less catastrophic failures were observed without post reconstruction.

The effects of dowel design and load direction on dowel-and-core restorations

STATEMENT OF PROBLEM

Complications such as loosening of the dowel and core or fracture of the remaining tooth root can be influenced by many factors, including the amount of remaining dentin, direction of the occlusal load, and design of the dowel. Most stress analyses of dowel and cores were conducted without including all aspects of the restorations and supporting structures.

PURPOSE

The purpose of this study was to investigate the influence of occlusal stresses on various dowel designs in a restored, endodontically treated maxillary incisor by using a 2-dimensional finite element analysis model.

MATERIAL AND METHODS

A 2-dimensional finite element model was constructed in a labiolingual cross-sectional view of a maxillary central incisor, a dowel, a core, and the supporting tissues to investigate stresses in various dowel designs. As a control, a metal-ceramic crown on an endodontically treated tooth without a dowel and core was modeled. A 10-kg force was applied as follows: (1) in a vertical load on the incisal edge, (2) in a horizontal load on the labial surface, and (3) in a 20-degree diagonal load on the lingual surface.

RESULTS

The use of a dowel reduced the peak dentinal stress to 75% of the magnitude of the control. When a vertical force was applied, the magnitudes of stress of the various dowel designs were similar; however, when loaded horizontally, the short dowel produced the greatest dentinal stress concentration, and the tapered dowel showed the greatest stress concentration within the cement layer. Greater deflections and higher stresses were generated with horizontal loading.

CONCLUSION

The dowel and core provided little reinforcement to the remaining tooth. The direction of the functional load had a greater effect than dowel design on maximum stress and displacement. Parallel-sided dowel and cores with a length of 12 mm distributed the stress widely in the restoration and dentin, resulting in the smallest stresses.

Survival rate and fracture strength of incisors restored with different post and core systems after exposure in the artificial mouth

The survival rate and fracture resistance of 40 decapitated endodontically treated maxillary central incisors using four different post and core systems covered with all-ceramic copings was evaluated after exposure in the artificial mouth. Ten samples of the following post and core systems were investigated: high precious metal post (Permador) and core (Olympia) (A), zirconia post (Cerapost) with a pre-fabricated bonded ceramic core (Ceracap) (B), resin-ceramic post (experimental) with a pre-fabricated bonded ceramic core (Ceracap(R)) (C) and a zirconia post (Cerapost) with a custom made ceramic core (Cosmo Ingots) (D). The all-ceramic copings (Procera) were cemented using Panavia TC. The survival rates after 1 200 000 cycles in the artificial mouth are as follows: 90% (A), 80% (B), 60% (C) and 100% (D). The results of the means and standard deviations (s.d.) of the fracture resistance during static loading are: 1270 +/- 312.5 (A), 1494.5 +/- 333.5 (B), 1146.7 +/- 182.6 (C) and 463.3 +/- 46.2 (D). There are statistically significant differences between all groups with the exception of A and B, and A and C (Wilcoxon test). None of the zirconia posts with custom made ceramic cores covered with all-ceramic copings fractured during dynamic loading in the artificial mouth. The mean fracture strength during static loading was less favourable than that of groups A, B and C but above the clinical necessary level.

An in vitro study into the effect of the ferrule preparation on the fracture resistance of crowned teeth incorporating prefabricated post and composite core restorations

AIM

This in vitro study investigated the effect of a ferrule preparation on the fracture resistance of crowned central incisors incorporating a prefabricated post (Parapost) cemented with Panavia-Ex and with a composite core.

METHODOLOGY

The test group consisted of 10 post crowned natural central incisor teeth with a 2-mm wide ferrule preparation, whilst the control group of 10 teeth had no ferrule. The specimens were mounted on a Lloyd universal testing machine and a compressive load was applied at an angle of 135 degrees to the palatal surface of the crown until failure occurred.

RESULTS

In both groups, failure occurred at higher loads compared with previous studies. The mean failure load was 1218 N for the unferruled group and 1407 N for the ferruled group. Statistical analysis showed no significant difference between the groups.

CONCLUSIONS

Under the conditions of this study, when composite cement and core materials are utilized with a Parapost prefabricated system in vitro the additional use of a ferrule preparation has no benefit in terms of resistance to fracture.

Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite

STATEMENT OF PROBLEM

Veneer preparations are considered to weaken endodontically treated maxillary incisors. Prefabricated posts have been controversially indicated to reinforce endodontically treated teeth before final restoration.

PURPOSE

This in vitro study evaluated whether (1) veneer preparation in enamel or in enamel/dentin weakens endodontically treated maxillary incisors, (2) bonding of direct composite veneer restores the original strength of the unprepared teeth, and (3) use of prefabricated metal posts increases fracture resistance of prepared and restored teeth.

MATERIAL AND METHODS

Ninety extracted human maxillary central incisors were submitted to conventional root canal treatment. Specimens were randomly divided into 8 experimental groups (veneer preparation in enamel or dentin with/without post and with/without direct composite veneer restoration) and a control group (n = 10). Specimens were loaded to fracture, and the data were analyzed statistically.

RESULTS

Statistical analysis revealed that a conservative veneer preparation does not significantly reduce maxillary incisors' fracture resistance. For prepared incisors, bonding of direct composite veneer restored their original strength, and the use of posts did not increase their fracture resistance.

CONCLUSION

Conservative veneer preparations involving enamel and enamel/dentin did not significantly reduce the fracture resistance of endodontically treated maxillary incisors. In addition, restoration of the intraenamel preparations with direct composite resulted in teeth more resistant to fracture than teeth having restorations in dentin. The use of posts did not improve fracture resistance of endodontically treated maxillary incisors reduced and veneered with direct composite.

Torsional resistance of crowns cemented to composite cores involving three stainless steel endodontic post designs

STATEMENT OF PROBLEM

There are no studies analyzing the effects of a crown in relationship to torsional resistance for a titanium-reinforced core material supported by a post.

PURPOSE

This study investigated the effects of post design on the torsional resistance of a crown supported by a titanium-reinforced composite core material (Ti-Core) and 3 endodontic posts (AccessPost, Flexi-Post, and ParaPost).

MATERIAL AND METHOD

Three groups of 10 specimens per group were studied. A total of 30 recently extracted human single-rooted (incisors) teeth with their crowns removed were used. Post holes preparations were created according to manufacturer's instructions. All posts were cemented using Flexi-Flow with titanium cement. Scotchbond Multi-Purpose bonding system was used as the bonding system for all groups. All cores were fabricated with Ti-Core with titanium core material with hard copper bands as the matrix. The Ti-Core core material was allowed to set for 1 hour. Metal crowns were fabricated and cemented with zinc phosphate cement. Specimens were placed in a special jig and a clockwise torsional force was applied. Torsional force was measured on a Lebow 1102-200 torque transducer and recorded on a Hewlett Packard 7015B X-Y recorder in inch x ounce. A 1-way analysis of variance (ANOVA) was used to test for statistical significance (P < .001).

RESULTS

The torsional values (inch x ounce) were AccessPost 77.2 +/- 30.3, Flexi-Post 162.2 +/- 51.2, and ParaPost 60.9 +/- 28.4. SNK and Scheffé comparison tests revealed that the Flexi-Post group had significantly greater resistance to torque loading than the AccessPost and ParaPost groups, which were statistically similar to each other.

CONCLUSION

Post design has an effect on torsional resistance of a crown supported by titanium-reinforced core build-up and post. The threaded split-shank design of the Flexi-Post dowel offers significantly greater resistance to torsional loading than the passive posts studied.

Furcation groove of buccal root of maxillary first premolars--a morphometric study

Furcation grooves on the palatal aspect of the buccal roots of 35 maxillary first premolars, randomly selected, were assessed and found to exist in 97% of the sample. The buccal roots were sectioned into slices, 1 mm thick, and morphometric horizontal and vertical measurements were taken by a Toolmaker Microscope. The slice with the deepest invaginations served as the reference plane. The deepest invaginations were found to be at a mean distance of 1.18 mm from the bifurcation, with a mean depth of 0.4 mm. The canal had a kidney-shaped appearance in cross-section, and the mean distance from the invagination to the canal wall was 0.81 mm. It is thus hazardous to use rotary instruments for flaring these roots and any circular-shaped post space preparation at this level is contraindicated. The outcome of such procedures might be root thinning, perforation, or vertical root fracture, thus causing a poor prognosis.

Foundation restorations in fixed prosthodontics: current knowledge and future needs

PURPOSE

The Ad Hoc Committee on Research in Fixed Prosthodontics established by the Academy of Fixed Prosthodontics publishes a yearly comprehensive literature review on a selected topic. The subject for this year is foundation restorations.

METHODS

Literature of various in vitro and in vivo investigations that included technical and clinical articles was reviewed to provide clinical guidelines for the dentist when selecting methods and materials for restoration of structurally compromised teeth. Topics discussed and critically reviewed include: (1) desirable features of foundation restorations, (2) foundations for pulpless teeth, (3) historic perspectives, (4) cast posts and cores, (5) role of the ferrule effect, (6) prefabricated posts, (7) direct cores, (8) foundation restorations for severely compromised teeth, (9) problems and limitations, (10) future needs, and (11) directions for future research.

CONCLUSION

This comprehensive review brings together literature from a variety of in vitro and in vivo studies, along with technique articles and clinical reports to provide meaningful guidelines for the dentist when selecting methods and materials for the restoration of structurally compromised teeth.

Pilot study of the effects of three bonding systems on the torsional resistance of a titanium-reinforced composite core

STATEMENT OF PROBLEM

There are no studies analyzing the effects of a bonding agent on torsional resistance for a titanium-reinforced core material bonded with a multistep bonding system.

PURPOSE

This pilot study investigated the effects of multistep bonding agents on torsional resistance of a titanium-reinforced composite core material (Ti-Core core material).

MATERIAL AND METHODS

A total of 40 recently extracted human molars with their crowns removed were placed into acrylic resin blocks and divided into 4 groups of 10 specimens. Only multistep bonding systems were used (AllBond-2, ScotchBond Multi-

PURPOSE

Tenure A&B, and the control without bonding agent). Specimens were prepared according to manufacturer's instructions. The control group was etched with a 37.5% phosphate acid. All cores were fabricated with Ti-Core titanium core material with No. 1 hard copper bands as the matrix. Ti-Core core material was applied and allowed to cure for 1 hour, then the cores were placed in 100% humidity (water) for 1 week. Test specimens were placed in a special jig and a clockwise torsional force applied. Torsional force was measured on a Lebow 1102-200 torque transducer and recorded on a Hewlett Packard 7015B X-Y recorder in inch x ounce then converted into Newton-meter. One-way analysis of variance (ANOVA) was used to test for statistical significance (P <.05).

RESULTS

Torsional values (Newton-meter) were AllBond-2, 0.1980, ScotchBond Multi-

PURPOSE

0.1890, Tenure A&B, 0.2142; the control group recorded a value of zero. Statistical analysis revealed that bonding systems did not differ from one another.

CONCLUSION

Use of a bonding agent increased the core's resistance to torsional forces. Lack of a bonding agent dramatically reduced the resistance to torque.

Variations in planning fixed bridgework--a group of dentists at a case-based postgraduate course

Variations in treatment planning and prescription have been described in relation to routine restorative dentistry. This study examined dentists' decisions regarding treatment planning for fixed bridgework. Fifty five dentists who attended a Continuing Education course on fixed bridgework were given standard information about a patient in the form of study casts, photographs of radiographs and a clinical history. They were asked to design a bridge where a previous one had failed and to complete a proforma which was returned to the course organisers in advance of the event. The response rate was 65%. The data showed wide variation in identification of features of diagnostic importance. Seventy percent of respondents chose to use again as abutments teeth which were extensively damaged and had failed to retain the previous bridge: while only 30% noted features of the occlusion which if left unchanged would have precluded a successful bridge from being made. A further feature was that nearly 70% chose to use multiple abutments to support the bridge. The implications of these results were discussed with respect to current concepts of bridge design.

Effects of three bonding systems on the torsional resistance of titanium-reinforced composite cores supported by two post designs

STATEMENT OF PROBLEM

There are no studies that have investigated the effects of bonding agents on the resistance to torque of a composite core supported by a prefabricated post.

PURPOSE

This study investigated the ability of bonding agents to resist rational forces applied to titanium-reinforced composite cores supported by 2 post designs.

MATERIAL AND METHODS

Two post designs (AccessPost and ParaPost dowels) with titanium-reinforced core material and 4 bonding conditions (AllBond-2, ScotchBond Multi-Purpose, Tenure A&B, and without a bonding agent) were studied. A total of 80 specimens in 8 experimental groups were prepared and subjected to clockwise torsional forces until failure.

RESULTS

Torsional values ranged from 53.31 in. x oz (ParaPost/ScotchBond Multi-Purpose) to 72.31 in. x oz (AccessPost/ScotchBond Multi-Purpose). Two-way of analysis of variance failed to demonstrate a significant difference among posts or type of bonding system.

CONCLUSION

The use of a multistep bonding agent had no significant effect on the torsional resistance of a core supported by a passive endodontic post.

Factors affecting retention of post systems: a literature review

STATEMENT OF PROBLEM

An extensive review of the published literature has revealed a wide divergence of opinion regarding the suitability of different post systems for endodontically treated teeth. As a result, the dentist has no clear guidelines concerning the selection of suitable post systems that will provide adequate retention while minimizing subsequent root fracture.

PURPOSE

This study formulated, through the literature search, a set of guidelines to assist the dentist in selecting an endodontic post system that would optimize retention while limiting root fracture.

RESULTS

For most clinical situations, the literature indicates that a passive parallel-sided post will, in the hands of the average practitioner, allow the dentist to successfully restore most endodontically treated teeth.

In vitro evaluation of a carbon fiber post

The purpose of this study was to evaluate the influence of endodontic and restorative procedures on fracture resistance of teeth, and to compare the incidence of root fracture in teeth with clinical crowns removed that were restored with three different types of post and a composite core build-up. Seven groups of 10 extracted maxillary canines were used. A control group had only a crown preparation, but no endodontic treatment. Three groups had endodontic treatment, crown preparation, and the access restored. Three groups had endodontic treatment, the crown totally removed, a tapered, parallel, or carbon post placed, and a composite build-up. All specimens were subjected to a 45-degree load at 0.5 mm/min until failure occurred. The force at failure and the location of fracture were recorded. The groups with post and composite build-ups failed at significantly lower force than the teeth in which the crowns had not been removed. There were no significant differences in the amount of force required to produce failure among the three groups with different posts and a composite build-up. The group restored with the carbon post had no root fractures, whereas there were five fractures in each of the parallel and tapered post groups.

Esthetic restoration of endodontically treated teeth: factors that affect prognosis

Restoration of endodontically treated teeth involves a complex system of components and component interfaces designed to resist force. Dental materials, forces on teeth, clinical circumstances, and restorative design determine restoration success. A new classification evaluates number of canals, amount of remaining tooth surface, chamber space, canal quality, and canal orientation.

A retrospective study of 236 patients with teeth restored by carbon fiber-reinforced epoxy resin posts

STATEMENT OF PROBLEM

The Composipost dowel is made of stretched, aligned carbon fibres embedded in an epoxy-resin matrix. It is widely used in Europe and Canada for the restoration of endodontically treated teeth and was introduced in the United States 2 years ago as the C-Post dowel.

PURPOSE

This retrospective study evaluated treatment outcome of the Composipost system after 2 to 3 years.

MATERIAL AND METHODS

A total of 236 patients treated during a 1-year period by seven Swedish dental practitioners were included. Of those, 146 patients consented and data were collected from the dental records of the remaining patients. Thus, the material comprised 236 teeth restored with carbon fiber-reinforced epoxy resin post, 130 maxillary and 106 mandibular teeth, with a mean restoration time of 32 months (range 27 to 41). Periodontal conditions, radiographic signs, and prosthodontic results were recorded.

RESULTS

Five teeth (2%) had been extracted for reasons unrelated to the Composipost system. Periodontal conditions such as plaque accumulation, gingival health, bleeding on probing, and pocket depth around the teeth with Composipost dowels were similar to the control teeth. No dislodgment or root or post fractures were observed clinically or on radiographs. Radiographic examination of bone height measured from the apex to the bone margin mesially and distally showed differences on the mesial side but not on the distal surface (p < 0.05) between the Composipost-treated teeth and the controls.

CONCLUSIONS

Promising results after 2 to 3 years of clinical service indicate that this system can be a viable alternative to conventional post-and-core systems.

Retention of three endodontic posts cemented with five dental cements

STATEMENT OF PROBLEM

The retention of a post is believed to be a major factor in restoration survival. Therefore the cement with the greatest in vitro retention property should give the best performance for a restoration.

PURPOSE

This study compared retentive values of three posts (Flexi-Post, AccessPost, and ParaPost) cemented with five cements (Flexi-Flow, zinc phosphate, Advance, Duet, and Ketac-Cem) plus a control group that consisted of a Flexi-Post No. 2 dowel without cement.

MATERIAL AND METHODS

A total of 160 recently extracted human single-rooted teeth with crowns removed at the cementoenamel junction were divided into 16 groups of 10 samples. Post holes were prepared according to manufacturers' instructions. Posts were then cemented with one of the five cements. Each sample was placed into a specialized jig and on a tensile testing machine with crosshead speed of 0.638 cm/minute, applied until failure. A two-way analysis of variance and Newman-Keuls multiple range comparison tests were performed for all cemented groups. A one-way analysis of variance and a Student-Newman-Keuls multiple range comparison test were performed only for the groups with the Flexi-Post dowel, this included the no cement condition, with significant results if p < 0.05.

RESULTS

Flexi-Post dowel with Flexi-Flow Natural cement obtained the highest retentive value (303.91 pounds). ParaPost dowel with Duet cement exhibited the lowest retention value (21.23 pounds). The Flexi-Post dowel demonstrated higher mean retention than AccessPost or ParaPost dowels, AccessPost dowel was higher than ParaPost dowel. Flexi-Flow cement had the highest overall mean retention followed, in decreasing order, by zinc phosphate, Advance, Ketac-Cem, and Duet cements.

CONCLUSIONS

Flexi-Post dowel was the most retentive post studied with values ranging from 303.91 pounds with Flexi-Flow Natural cements to 150.93 pounds without cement. Flexi-Flow cements had a higher overall mean retention than other cements studied.

Analysis of stress distribution in a maxillary central incisor subjected to various post and core applications

In this study, stress distribution in a maxillary central incisor that was subjected to endodontic treatment and various post and core applications was determined by using a three-dimensional finite-element method. Cast gold post and gold core and different combinations of prefabricated stainless steel post, or a prefabricated titanium post with amalgam or composite cores were considered. In all cases, the tooth was assumed to have a porcelain crown. The primary purpose of the study was to evaluate the stress distribution due to simulated biting forces and thus investigate the reliability of different post and core applications. It was found that, within the limitations of the study, the cast gold post and gold core application yielded the best result. The second purpose of the study was to highlight the importance of using a unique stress value, which contains the effects of all the possible stress components existing upon loading in the determination of a possible failure. A resultant stress value and all the constituent components were shown in detail, and it was proved that an estimation independently based on an individual component might lead to erroneous results.

Effect of different surface textures on retentive strength of tapered posts

STATEMENT OF PROBLEM

Tapered posts allow for the preservation of tooth substance in the fragile apical area and are advantageous in clinical situations where they conform to the root and canal configuration of endodontically treated teeth. However, their lower retention compared with passive parallel-sided or active threaded posts is a disadvantage.

PURPOSE

This study determined the retentive strength of tapered titanium posts with different surface textures and examined the effect of roughening dentinal walls of the prepared post space.

MATERIAL AND METHODS

Posts with four surface configurations (smooth, with and without grooves, and sandblasted, with and without grooves) were examined when cemented in extracted anterior teeth.

RESULTS

The smooth post showed the lowest retentive strength. Sandblasting the smooth post more than doubled its retentive strength. The retentive strength of both smooth and sandblasted posts could be further increased by the addition of circumferential grooves. Roughening the dentinal walls of the prepared post space increased the retentive strength of sandblasted posts with and without grooves even more.

CONCLUSIONS

These findings indicated that, when a tapered post is used, roughening the dentin canal wall, as well as sandblasting and grooving the post, can provide statistically significant additional resistance to dislodgment.

An in vitro investigation of cast post and partial core design

OBJECTIVES

Following endodontic therapy, the provision of a cast post and core restoration may be indicated. Many authors advocate retaining sound coronal dentine where possible, improving the resistance to fracture of the endodontically treated tooth. However, there is little conclusive experimental evidence to support this recommendation. This laboratory study was designed to investigate the effect of retained sound coronal dentine on the strength of a tooth restored with a cemented post and partial core restoration under direct loading.

METHODS

Specimens with retained coronal dentine buccally, lingually, or buccally and lingually were restored with cast post and partial cores and tested to failure using an Instron Universal Testing Machine, Model 1195. Control post and full core restorations were also tested. The mode of failure for all specimens was recorded photographically.

RESULTS

Teeth with retained buccal coronal dentine and post and partial cores were significantly less resistant to failure than controls with post and full cores (P < 0.01), failure occurring through crack initiation and propagation at the junction of the cast partial core and dentine core. There was no statistically significant difference in the strength of teeth with retained lingual coronal dentine or buccal and lingual dentine when compared to the control.

CONCLUSIONS

In conclusion, this in vitro model demonstrates that retained coronal dentine will not strengthen a tooth restored with a cast post and partial core. The clinical benefit of retaining buccal coronal dentine is brought into question when set against the increased technical effort and difficulty of producing the restoration in the dental technical laboratory and the possible overriding benefit of ferruling the crown margin onto a sound root structure.

Restoration of pulpless teeth: application of traditional principles in present and future contexts

Posts were recommended more than 100 years ago to retain artificial crowns. Recent studies suggest that posts can weaken teeth; therefore restorative procedures that help preserve pulpal vitality and eliminate the need for posts are desirable. If endodontic therapy is unavoidable, conservation of remaining tooth structure is most important. When a post is required to retain a core for an artificial crown, a custom cast post is the most effective means of conserving tooth structure. The length of the post should not be compromised, although 4 to 5 mm of apical gutta-percha must be maintained. The restorative prognosis is improved if the width of the post does not exceed one half the width of the root, and the cemented artificial crown should extend apical to the core to provide a 1.5 to 2 mm ferrule. Complex procedures have allowed the dentist to restore extensively damaged teeth. However, extraction and replacement with implant-supported prosthodontics may be more prudent with severely compromised teeth.

Comparison of the torsional forces at failure for seven endodontic post systems

Resistance to torsional forces is critical in restoration of endodontically treated teeth. Seven post designs (Flexi-Post, Flexi-Flange, Para-Post, AccessPost, World Post, Vlock, and Dentatus posts) were cemented in roots of natural teeth with zinc phosphate and Flexi-Flow cements, which resulted in 11 different groupings that were subjected to torsional forces in a clockwise direction. In addition, clockwise and counterclockwise torque was applied to the Flexi-Post and Flexi-Flange systems cemented with zinc phosphate and Flexi-Flow cements. A total of 150 samples were prepared, and groups for this study were: group 1, Flexi-Post/zinc phosphate clockwise and counterclockwise; group 2, Flexi-Post/Flexi-Flow clockwise and counterclockwise; group 3, Flexi-Flange/zinc phosphate clockwise and counterclockwise; group 4, Flexi-Flange/Flexi-Flow clockwise and counterclockwise; group 5, Para-Post/zinc phosphate clockwise; group 6, AccessPost/zinc phosphate clockwise; group 7, AccessPost/Flexi-Flow with grooved dentin clockwise; group 8, World Post/zinc phosphate clockwise; group 9, World Post/Flexi-Flow with grooved dentin clockwise; group 10, Vlock Post/zinc phosphate clockwise; and group 11, Dentatus post/zinc phosphate clockwise. Torsional forces for the groups ranged from 17 ounce-inches (Dentatus/zinc phosphate) to 81 ounce-inches (Flexi-Post/zinc phosphate). Flexi-Post and Flexi-Flange threaded posts exhibited statistically greater resistance to torsional forces. Analyses were computed with one-way and three-way analysis of variance followed by Duncan's multiple range test. Duncan's multiple range test indicated that Flexi-Post/zinc phosphate/clockwise was similar to Flexi-Post/Flexi-Flow/clockwise and that both had significantly higher torque levels than the other treatment conditions in the clockwise direction (p 0.0001). Dentatus/zinc phosphate/clockwise had significantly lower torque levels than the other treatment conditions (p 0.031).

General dentists' patterns of restoring endodontically treated teeth

The manner in which endodontically treated teeth are restored influences tooth longevity and the cost of treatment. This article describes a study of how surveyed general dentists restored endodontically treated teeth and whether their methods were consistent with those suggested in the literature. Some patterns of restoration did reflect the literature's recommendations, but overall the findings call into question some of the ways in which post-endodontic restorative care is carried out.

Survival rate and failure characteristics for two post designs

The dental records of 638 patients treated with 788 posts and cores were studied to analyze failure rate and failure characteristics for two post designs. Frequency of the technical failures, loss of retention, root fracture, and post fracture were recorded 4 to 5 years after post cementation. There were two types of posts: custom-cast tapered posts and parallel-sided serrated posts. The cumulative failure rate was 15% for 456 tapered posts and 8% for 332 Para-Post posts. Loss of retention was the most frequent reason for failure for both types of posts, whereas root fractures had the most serious consequences, and all resulted in extraction. A significantly higher success rate was recorded for parallel-sided serrated posts, compared with custom-cast posts, regarding the total failure rate and the severity of the failure (p < 0.05).

The mandibular incisor: rethinking guidelines for post and core design

In post and core research, little attention has been given to the tooth with minimal bulk and mesialdistal width. The purpose of this in vitro study was to investigate retention and fracture characteristics of lower incisors restored with variable dowel designs. Fifty freshly extracted mandibular incisors were endodontically treated. Four groups of 10 teeth, decoronalized and dowel- and core-restored, were tested for retention characteristics and fracture resistance. One group of 10 teeth restored with composite resin in intact natural crown acted as controls. Dowel variables included a prefabricated round cross-sectional design and a morphologic dowel that reproduced the canal space. A universal testing machine created tensile and transverse loads, and failure was measured and recorded. Results showed no difference in resistance to transverse loading between morphological and standardized dowels (p > 0.05). However, when analyzing modes of failure, ferruled morphological post and core design was less likely to result in a catastrophic root or post fracture. In addition, morphological dowels were significantly more retentive than standardized round dowels in teeth with narrow cross-sections (p = 0.007). This study also reaffirmed the findings of previous investigations, that the intact natural crown of an endodontically treated tooth provides maximum resistance to root fracture.

Retention of posts cemented with various dentinal bonding cements

This investigation evaluated the retention of preformed posts with four different cements: C & B Metabond, Panavia, All-Bond 2, and Ketac-Cem. Sixty intact maxillary canines were selected for the study. The clinical crowns were removed and endodontic therapy done on each root, which was then prepared to receive prefabricated posts. The 60 samples were divided into four groups of 15, and the posts in each group were cemented with one of the four cements. The roots were mounted in acrylic resin blocks and the posts were separated from the canals with an Instron testing machine. Analysis of the forces needed to dislodge the posts with analysis of variance and Student-Newman-Keuls test disclosed that C & B Metabond cement was the most retentive (p < 0.05). No difference in retention was recorded between Ketac-Cem and Panavia cements. All-Bond 2 cement was the least retentive of cements.

The prosthodontic management of endodontically treated teeth: a literature review. Part I. Success and failure data, treatment concepts

Part I of this three-part literature review discusses the incidence of endodontic treatment required after prosthodontic procedures, whether crowns are needed on endodontically treated teeth, the primary purpose of posts, the causes of post and core failure, root fracture incidence data, and post design considerations. Pertinent questions are addressed based on the past 25 years of dental literature.

Resistance to fracture of endodontically treated premolars restored with new generation dentine bonding systems

MOD cavities in 60 endodontically treated teeth were restored using six different methods. Copper rings were filled with commercial hard-setting cement and the teeth were placed up to the level of the cemento-enamel junction. The teeth were grouped according to restorative method, mounted in an Instron TT machine, and the buccal walls subjected to a slowly increasing compressive force until fracture occurred. The force of fracture of the walls of each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner irrespective of the restorative method used. All groups restored with the newer bonding system had higher resistance to fracture than those restored with an acid etch chemically cured composite resin technique. The groups restored with Den-Mat Tenure Core Paste or a Variglass VLC base and Prisma APH were significantly stronger than the acid etch Concise restored teeth (P < 0.05). No statistically significant differences were found between the other groups (P > 0.05).

Three-dimensional finite element analysis of the effects of posts on stress distribution in dentin

A finite element analysis was conducted to study the influence of posts on dentinal stress in pulpless teeth. Three-dimensional models of an intact Chinese maxillary central incisor with and without post restoration were analyzed. When the tooth was subjected to masticatory and traumatic loads, stress distributions in dentin were similar whether or not the post was present. Maximal dentinal stresses were reduced by only 7% to 10% and 10% to 14.5%, respectively, with gold alloy and stainless steel posts. Thus the reinforcement effects from posts appeared limited in pulpless incisors.

Biomechanical considerations in restoring endodontically treated teeth

Various concepts for dental treatment have been established without appropriate documentation, such as restoration of endodontically treated teeth. Some researchers and dentists strongly recommend including a post with the restoration to strengthen the root. Other studies have indicated that posts may substantially weaken the roots and should be avoided. An additional approach suggested that the post did not improve the resistance to fracture during occlusion and did not support the restoration. Biomechanical problems are analyzed, and a recommended clinical approach is presented.

Comparison of the photoelastic stress for a split-shank threaded post versus a threaded post

PURPOSE

This study compared the stress distribution during insertion and after cementation for two prefabricated endodontic posts, (1) a split-shank threaded post, and (2) a threaded post with no split in the shank.

MATERIALS AND METHODS

Three test blocks of photoelastic material were prepared with simulated endodontic canals for each group studied. Specimens were then photographed after insertion and cementation.

RESULTS

Minimal stresses were observed for the post with a split (group 1) throughout the length of the shaft, whereas asymmetric patterns of stresses for the post without a split (group 2) were present. Stress distribution for the post without a split were concentrated more apically rather than coronally.

CONCLUSIONS

The presence of a split reduces insertion and cementation stresses for this post system. The split also acts as a vent during the cementation of the post into the canal and minimizes stress concentration during cementation.

Retentive properties of three post-core systems

The retention in root canals of Flexi-Posts, Para-Posts and Brasseler/Vlock-Posts was measured using tensile and compressive/shear forces. Forty-two extracted maxillary anterior teeth were embedded in self-curing acrylic resin and treated endodontically. Each root canal was prepared with the appropriate matching drills for the post-core system chosen. Each post-core was cemented in the canal with zinc phosphate cement. A tensile force was applied along the long axis of each tooth and the force needed to dislodge the post-core was recorded. There was no difference in retention between the small diameter posts, but the difference between the medium and the large diameter posts, however, was significant. In the medium diameter post group, the Flexi-Post was approximately twice as retentive as the other two post-core systems evaluated. In the second series of tests compressive/shear force was applied at an angle of 130 degrees to the long axis of the tooth. The retention difference between the small diameter posts was found to be statistically significant, Flexi-Posts being more retentive than Para-Posts and B/V-Posts.

Comparison of the retentive properties of two hollow-tube post systems to those of a solid post design

The retention of a post in a root is critical for the successful restoration of an endodontically treated tooth. This study compared the retention of two hollow-tube post designs (Access post and World post) cemented with zinc phosphate cement or a titanium-reinforced composite resin cement (Flexi-Flow cement with titanium) with that of the control Para-Post system, a solid post design cemented with zinc phosphate cement. The experiment was divided into 11 groups of 10 samples. Retentive values were measured with a universal testing machine and the data were recorded in pounds. A one-way analysis of variance was computed and included Duncan's multiple comparisons test, Tukey's Student range test, and Dunnett's test. Duncan's multiple comparison test and Tukey's test were inconclusive. Only Dunnett's test revealed a significant difference between group 5, Access post, grooved dentin with Flexi-Flow cement with titanium (mean of 89.7 lb), and the control, group 11, Para-Post dowel cemented with zinc phosphate cement (mean of 61.3 lb). All other groups exhibited similar results with retentive values that ranged from 62 to 76 lb.

Clinical success of cast metal posts and cores

The topic of posts for endodontically treated teeth has received considerable attention in the literature, but there is sparse in vivo research and certain information from in vitro investigations is contradictory. A retrospective study of 1273 endodontically treated teeth in the practices of nine dentists in general practice indicated an inordinately high failure rate with cast posts and cores compared with alternate systems of coronoradicular stabilization. However, a closer evaluation of the data in this study indicated that almost half of the cast posts were half the desired length or less. The indications for the cast post and core are discussed and the specific causes of failure are reviewed. Additional research is needed to compare the success rate of securely seated cast posts and cores with alternate methods of coronoradicular stabilization.

The relationship between the root canal filling and post space preparation

The restoration of root treated teeth often requires the use of posts. Their use may affect the quality of the seal of the root canal filling. The various aspects of the relationship between root canal filling and post space preparation are discussed in this review. It is recommended that the use of posts should be avoided whenever possible. Where the preparation of post space is required, immediate removal of gutta-percha using heated instruments and small Gates Glidden drills is the method of choice.

Effect of post design on resistance to fracture of endodontically treated teeth with complete crowns

The effect of post design on the fracture resistance of endodontically treated premolars restored with cast crowns was examined in vitro. The experimental model used cast posts and cores to test the effect of post design in a post-core system with identical rigidity. Samples loaded on an Instron testing machine until failure revealed that post design did not influence the fracture resistance of endodontically treated premolars restored with complete cast crowns. There was also no statistically significant difference between restored teeth with or without cast posts and cores.

The resistance to tensile, compression, and torsional forces provided by four post systems

This study measured the force required to displace four different endodontic posts (an experimental, Para-Post, Flexi-Post, and V Lock) when tensile, torsion, or compressive forces were applied. Extracted mandibular premolars were decoronated at the cementoenamel junction, the roots were divided into groups of similar size, and the pulpal tissue was removed. The canals were enlarged, cleaned, and filled with gutta percha. Post preparations were made, and the posts were cut and cemented into the post spaces with resin cement. The roots were notched with a separating disc and lowered into a metal tube filled with acrylic resin. Two Minim pins were placed into the coronal dentin paralleling the post. Composite resin cores were made around the coronal 4 mm of the posts and the two pins for 10 specimens from each group. The specimens were placed into a standardized fixture and a load applied until failure. The tensile load required to pull the experimental post and resin was significantly less than the load required to remove the threaded posts. Flexi-Posts provided the greatest resistance to torsion and tensile loading. The compressive load required to fracture the core over the V-Lock post was significantly greater than the other post systems.

Retention properties of a split-shaft threaded post: cut at different apical lengths

The retention of the post to the root of an endodontically treated tooth is critical for a successful restoration. Modification of the post length to accommodate a specific clinical situation is common. This study compared the retention of No. 1 and No. 2 Flexi-Post restorations shortened apically from 1 to 5 mm with that reported for full-length control No. 1 and No. 2 Flexi-Post dowels. The experimental material was divided into 10 groups with 10 samples in each group. Retentive values were recorded in pounds with a universal testing machine. Analysis of variance with a Tukey-Student range, multiple-comparison test showed no statistical differences from apical reductions of 1, 2, 3, and 5 mm including the full-length control Flexi-Post No. 1 system. With 4 mm of apical shortening statistically greater retention was recorded. No statistical differences resulted with apical reductions of 1 to 4 mm or with the full-length control Flexi-Post No. 2 system, but 5 mm of apical shortening caused significantly less retention.

Retentive properties of threaded split-shaft posts with titanium-reinforced composite cement

The retention of posts in tooth roots is vital to the success of the restoration. This study compared the retention of posts of various sizes and diameters cemented with a titanium-reinforced composite cement with that of posts previously reported cemented with zinc phosphate cement. Four groups made up of 10 samples each were used and retention values were compared using a universal testing machine. Two-way analysis of variance and the Newman-Keuls multiple range comparison test were performed. Larger diameter posts cemented with titanium cement had better retention than similar posts cemented with zinc phosphate cement. The statistical increase in retention for the larger size posts is probably the result of the deeper channels (threads) in the dentin and the higher cohesive strength for the titanium-reinforced composite resin.