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Wang X, Zhong S, Ma D, Liu C, Liu Y, Zhao Y, Bai S. Polyetheretherketone split post and core for restoration of multirooted molar with insufficient dental tissue remnants by digital techniques: a case report and 3-year follow up. BMC Oral Health 2024; 24:904. [PMID: 39112986 PMCID: PMC11304810 DOI: 10.1186/s12903-024-04666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/24/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Multi-rooted teeth with extensive dental defects often face challenges in stability and biomechanical failure. High-performance polymer PEEK materials, with properties closer to dentin, show promise in reducing stress concentration and preserving tooth structure. This report aimed to explore the use of a highly retentive polyetheretherketone (PEEK) for manufacturing custom-made split post and core for the restoration of grossly destroyed endodontically treated molars. CLINICAL CONSIDERATIONS A 40-year-old female patient presented with complaints of loss of tooth substance in the posterior mandibular tooth. This case involved the digital design and fabrication of PEEK split post and core to restore multirooted molar with insufficient dental tissue remnants. The restorations were evaluated over a 3-year follow-up using the World Federation criteria (FDI). The restoration was clinically evaluated through intraoral examination, radiographic assessment, and subjective patient satisfaction, and was deemed clinically good according to FDI criteria. CONCLUSION The outstanding mechanical properties of PEEK, coupled with the structure of the split post, provide an effective treatment option for weakened multirooted teeth. Simultaneously, the restoration configuration effectively addressed the challenge of varying postinsertion directions, and the interlocking mechanism between the primary and auxiliary posts enhanced the stability of the post and core.
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Affiliation(s)
- Xin Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Sheng Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Dan Ma
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Chen Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Yuchen Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Yimin Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Shizhu Bai
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China.
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Vogler JAH, Abrahamian W, Reich SM, Wöstmann B, Rehmann P. Post and Core Treatment to Refit Telescopic Crown-Retained Dentures after Abutment Tooth Fracture: An Evaluation of Therapy by Retrospective Survival Analysis. Dent J (Basel) 2024; 12:224. [PMID: 39057011 PMCID: PMC11275264 DOI: 10.3390/dj12070224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/04/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Telescopic crown-retained dentures (TCDs) are one of the most common types of prosthetic restorations for partially edentulous patients; however, post and core (PC) treatment shows the worst survival probability if the tooth is used as an abutment for the TCD. Due to extra axial forces, abutment tooth fracture is a common cause of failure for TCDs; thus, PC treatment is often needed to refit the existing telescopic crown (TC). However, there are no clinical survival data on whether the PC treatment was used to refit the TC after abutment tooth fracture (PC2) or the PC was already fitted at the time of TCD treatment (PC1). A total of 246 patients with 399 PC treatments were retrospectively evaluated for follow-ups up to 17.33 years. The files were analysed for PC1 and PC2. Furthermore, the influence of the jaw, type of tooth, luting material, PC material, bone attachment, therapist and cause of failure was recorded. For statistical analysis, Kaplan-Meier and Cox regression analyses were conducted. PC2 showed highly significant lower survival probabilities than PC1 (p < 0.001). Moreover, the bone attachment and the age of the patient at the time of fitting the PC crown had an influence on the survival (p < 0.001). Therefore, PC2 should be carefully discussed with the patient and PC1 should be favoured in endodontically treated abutment teeth for TCDs.
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Affiliation(s)
- Jonas Adrian Helmut Vogler
- Dental Clinic—Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, 35392 Giessen, Germany
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Xiang F, Shi K, Hua H, Zhao J, Zheng Y. Restoration of teeth lacking complete ferrules using cast precious metal alloy post-and-cores and knife-edged crowns: A retrospective clinical study. J Prosthet Dent 2024:S0022-3913(24)00367-6. [PMID: 38942716 DOI: 10.1016/j.prosdent.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/30/2024]
Abstract
STATEMENT OF PROBLEM While the presence of a ferrule has been reported to be essential for post-and-core restorations, many extensively damaged teeth lack complete ferrules. The outcome of post-and-core restorations for these teeth remains uncertain. PURPOSE The purpose of this retrospective clinical study was to assess the outcome of cast alloy post-and-cores and knife-edged crowns for the restoration of teeth lacking complete ferrules. MATERIAL AND METHODS A total of 106 participants with endodontically treated teeth with 2 or fewer walls with ferrules who had received cast precious metal alloy post-and-cores along with knife-edged crowns between 2013 and 2022 were recalled for a clinical examination. The minimum follow-up time was 5 months after restoration, and restoration failure and the periodontal status difference between restored teeth and reference teeth were determined. Kaplan-Meier analysis was performed to obtain success curves. The influence of age, sex, jaw position, tooth type, and antagonistic dentition upon the success function was analyzed with the log-rank or Breslow test (α=.05). RESULTS A total of 100 participants with 130 restorations were studied. The success rate of the restorations was 93.85% in a mean ±standard deviation period of 48.3 ±26.1 months. The estimated 5-year cumulative success probability was 91.61%. No significant effect on the success of restorations was found regarding age, sex, jaw position, tooth type, or antagonistic dentition (P>.05). The main failure types were post debonding, root fracture, and apical periodontitis. No statistical difference in tooth mobility (Z=-1.265, P=.206) was found between the restored and the reference teeth, but the plaque index and calculus index of the restored teeth were significantly lower than of the reference teeth (Z=-7.216, P<.001; Z=-7.044, P<.001). Teeth that had received cast post-and-cores and knife-edged crowns were found to have no significant correlation with periodontal disease (χ²=1.131, P=.288) or bleeding on probing (χ²=3.436, P=.064). CONCLUSIONS The clinical outcomes for the restoration of teeth with 2 or fewer walls with ferrules using cast precious metal alloy post-and-cores and knife-edged crowns were favorable, exhibiting a high 5-year cumulative success probability and no increased periodontal health risk.
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Affiliation(s)
- Fangyue Xiang
- Graduate student, Graduate Prosthodontics, School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Keying Shi
- Graduate student, Graduate Prosthodontics, School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Haoyang Hua
- Graduate student, Graduate Prosthodontics, School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Jing Zhao
- Attending Physician, Department of General Dentistry, Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Yuanna Zheng
- Professor, School/Hospital of Stomatology, Zhejiang Chinese Medical University, Hangzhou, Ningbo Dental Hospital/Ningbo Oral Health Research Institute, Ningbo, PR China.
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Wang ZF, Fu BP. Minimum residual root dentin thickness of mandibular premolars restored with a post: A finite element analysis study. J Prosthet Dent 2024; 131:878-885. [PMID: 35489836 DOI: 10.1016/j.prosdent.2022.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
STATEMENT OF PROBLEM Thin root dentin after post space preparation will increase the risk of root fracture. However, the minimum residual root dentin thickness to be preserved after post space preparation is unclear. PURPOSE The purpose of this finite element analysis (FEA) study was to measure the residual root dentin thicknesses and analyze the stress distributions of post-restored mandibular premolars. MATERIAL AND METHODS The cone beam computed tomography (CBCT) data of 90 first and second mandibular premolars from Chinese participants (44 men, 46 women; aged between 20 and 79 years) were analyzed. Cross-sections 5 to 9 mm from the radiologic apex were used to measure the buccolingual and mesiodistal root diameters. The probability that the residual thickness of the buccolingual and mesiodistal root walls would be no less than 0.5, 0.6, 0.7, 0.8, 0.9, and 1 mm after post space preparation with a #2 Peeso reamer was calculated. Six 3-dimensional finite element models of cast post-restored mandibular premolars with 0.5, 0.6, 0.7, 0.8, 0.9, and 1 mm mesial and distal root dentin thicknesses were established. A static force of 100 N was applied to the buccal cusp tip at 45, 60, 75, and 90 degrees to the long axis of the tooth, and the maximum tensile stress and von Mises stress were analyzed. The Bonferroni post hoc test (αcorrected=.003) was used for multiple comparisons. RESULTS The buccolingual root diameter of mandibular premolars was wider than the mesiodistal root diameter. The probabilities that the mesiodistal residual root dentin thickness of mandibular first and second premolars at 5 mm from the apex would be no less than 1 mm after post space preparation with a #2 Peeso reamer were only 10% and 28%, respectively. The maximum tensile stress was at a minimum when the mesial and distal residual root dentin thickness was 0.6 mm in the external cervical dentin adjacent to the crestal bone and 1 mm in the apical dentin corresponding to the apex of the post. The maximum tensile stress of the mandibular premolar model with 0.6-mm mesial and distal residual root dentin thicknesses was lower than that with 0.9 mm and 1.0 mm thicknesses (Pcorrected<.001). CONCLUSIONS Short posts or smaller instruments for post space preparation are recommended to obtain a 1-mm residual root dentin thickness in the mesiodistal direction of mandibular premolars. If a 1-mm thickness cannot be preserved, a minimum residual root dentin thickness of 0.6 to 0.9 mm in the mesiodistal direction should be retained.
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Affiliation(s)
- Ze-Feng Wang
- Dental Attending Physician, Department of Prosthodontic, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, PR China
| | - Bai-Ping Fu
- Professor, Department of Prosthodontic, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, PR China.
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Ben Suleiman A, Desai S, Tepperman A, Chvartszaid D, Malkhassian G, Habsha E, Barzilay I, Azarpazhooh A. The Outcomes of Endodontically Treated Teeth Restored with Custom-Made Cast Post-and-Core Restorations: A Retrospective Cohort Study. J Endod 2024; 50:316-328. [PMID: 38158119 DOI: 10.1016/j.joen.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Custom-made cast post-and-core (CMCPC) restorations have long been used to restore structurally deficient endodontically treated teeth (ETT). However, the evidence regarding their impact on the outcomes of ETT is largely inconclusive. This study evaluated the long-term treatment outcome of ETT restored with CMCPC. METHODS This retrospective cohort study examined the dental records of patients that received CMCPC at a specialty private practice in Toronto, Canada between 1999 and 2021. The proportion of ETT with complete periapical healing and those that survived were estimated, and prognostic factors were investigated using multiple logistic and Cox regression analyses respectively (P < .05). RESULTS A total of 500 and 1000 teeth met periapical healing and survival criteria, respectively. The periapical healing rate was 88.8% and was associated with the presence of baseline periapical radiolucency [odds ratio = 0.1; 95% confidence interval (CI), 0.05-0.2; P < .001]. The survival after a median follow-up time of 52.9 months (interquartile range: 26.5-99.4) was 90.1% and was associated with <75% of root length in bone [hazard ratio (HR) = 2.6; 95% CI, 1.0-6.6; P = .033], type and quality of final restoration (HR = 2.09; 95% CI, 1.1-3.9; P = .020; HR = 2.3; 95% CI, 1.2-4.5; P = .008, respectively), and the presence of periapical radiolucency at the latest recall (HR = 3.2; 95% CI, 1.7-6.3; P < .001). CONCLUSIONS The outcome of ETT restored with CMCPC was favorable. CMCPC may be regarded as a viable restorative option for structurally deficient ETT.
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Affiliation(s)
| | - Shivani Desai
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adam Tepperman
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - David Chvartszaid
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada; The Alpha Omega Dental Centre, Baycrest Hospital, Toronto, Ontario, Canada
| | - Gevik Malkhassian
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Effrat Habsha
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada; Prosthodontic Associates Centre for Excellence, Toronto, Ontario, Canada
| | - Izchak Barzilay
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada; Prosthodontic Associates Centre for Excellence, Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Reich SM, Walther KA, Wöstmann B, Rehmann P, Vogler JAH. How long must a post be? A retrospective survival analysis on a large cohort with long follow-ups. J Dent 2024; 142:104879. [PMID: 38311019 DOI: 10.1016/j.jdent.2024.104879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES Post and core (PC) is frequently used, but clinical evidence concerning how long a post must be is scarce. Recommendations in dental literature range from half of the root which should be incorporated, to post space preparations conducted as deep as possible increasing the risk for root perforation thus tooth loss. Therefore, the aim of this retrospective survival analysis is to evaluate the post length as well as the post-clinical crown ratio on a large patient cohort with long follow-ups. MATERIALS AND METHODS Overall 1026 PC in 731 patients could be included in this study (2004-2023). The files were analysed due to the parameters post length and post-clinical crown ratio on X-Ray. Furthermore, the influence of the type of covering prosthetic restoration, location, type of tooth, luting material, PC material, bone attachment and therapist was evaluated. The statistical analysis was assessed using Kaplan-Meier (univariate influences) and Cox regression (multifactorial influences). RESULTS Survival until extraction as well as decementation was significantly influenced by bone attachment and covering prosthetic restoration. Posts reaching the middle third of the root showed highly significant (p < 0.001) better survival probabilities than those reaching the coronal or apical third. Regarding the post-clinical crown ratio, no significant difference was found for post = crown/post > crown, whereas post CONCLUSIONS The post space preparation should not be extended over the middle third of the root, but has to be deep enough to ensure that the post is at least as long as the clinical crown. CLINICAL SIGNIFICANCE Against the background of the large sample size and the long follow-ups, the results of this retrospective survival analysis are suitable to give general recommendations regarding how long a post has to be in order to ensure the best survival probability for PC treatment.
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Affiliation(s)
- Sarah Marie Reich
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Kay-Arne Walther
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Bernd Wöstmann
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Peter Rehmann
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Jonas Adrian Helmut Vogler
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany.
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Baik KM. Quality of post and core placement by final year undergraduate dental students. PLoS One 2023; 18:e0294073. [PMID: 37943743 PMCID: PMC10635463 DOI: 10.1371/journal.pone.0294073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
The success of endodontic restoration of badly compromised teeth depends on the quality of post and core placement and the extra-coronal restoration. Ensuring that students place posts to acceptable quality standards is therefore essential. The aim of this study was to radiographically evaluate post placement by final year undergraduate dental students and to identify any predictors of performance. Two hundred retrospectively and randomly selected posts placed by sixth year students were evaluated radiographically. Data on student gender; number and quality of radiographs; periapical pathology; tooth location; root canal treatment quality; amount of remaining gutta percha; gap between gutta percha and post; post-to-root width; crown-to-root ratio; and types of core material and crowns were recorded. Four criteria were used to grade post placement quality: (i) amount of remaining gutta percha; (ii) gap between gutta percha and post; (iii) post width to root ratio; and (iv) crown-to-root ratio. Assessments were scored to produce final grades. Data are presented using descriptive statistics and the chi-squared test was used to investigate whether student gender or tooth location were associated with final grade. Post and core quality was acceptable in most cases (97.5% were graded as adequate), with no differences in quality between male and female students nor according to tooth location (anterior, premolar, and molar). Just over half of radiographs were adequate quality (53.5%), while just under half were assessed as less than adequate (46.5%) due to cone cutting, overlap, shortening or elongation, although this did not affect formal assessment of post quality. General outcomes of post and core placement by undergraduate students were good, with few errors that might affect the prognosis and long-term survival of treated teeth. Providing undergraduate dental students with clear guidelines on when and how to take radiographs throughout the procedure may improve the quality of post and core treatment and reduce the risk of multiple unnecessary radiographic exposures. From the clinical perspective, although dental students generally place high quality posts and cores, it remains important to monitor the quality and performance of post placement as this determines the survival of compromised teeth.
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Affiliation(s)
- Khadijah M. Baik
- Faculty of Dentistry, Oral and Maxillofacial Prosthodontics Department, King Abdulaziz University, Jeddah, Saudi Arabia
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Vogler JAH, Stummer AL, Walther KA, Wöstmann B, Rehmann P. Survival of teeth treated with post and core - A retrospective study of more than 1000 cases with observation periods up to 18 years. J Dent 2023; 138:104723. [PMID: 37742809 DOI: 10.1016/j.jdent.2023.104723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVES Even if survival of post and core (PC) itself was frequently investigated in recent literature, clinical data concerning the risk for extraction of teeth restored with PC is still scarce. Since most authors found the loss of retention of refitable post and cores as the most common cause of failure, it is impossible to draw a conclusion on tooth survival on the results of those studies. Therefore, the aim of the present study was to improve the clinical evidence on the survival of teeth treated with post and cores on a large number of cases over a long observation period. MATERIALS AND METHODS 735 patients were treated with 1053 post and cores in the observation period (2004-2022) and could be included in the study. The patient files were analysed due to the parameters: Type of covering prosthetic restoration, location, type of tooth, luting material, post and core material, bone attachment and therapist. The survival probability was assessed using Kaplan-Meyer analysis. Cox regression was used to assess possible multifactorial influences. RESULTS The overall average survival time until necessary extraction of a tooth restored with a post and core was 11.74 years. A root fracture in primary crown retained removeable partial dentures (RPDs) during the first five years was the most common reason for extraction in this study. A significant influence on the survival time of teeth restored with post and cores was found for the type of covering restoration, bone attachment, age of the patient and post and core material. CONCLUSIONS Post and core restored teeth should be avoided as abutments for primary crown retained RPDs. CLINICAL SIGNIFICANCE If it is inevitable to utilise post and core restored teeth for primary crown retained RPDs, post and core materials with matching mechanical properties to that of dentine should be preferred.
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Affiliation(s)
- Jonas Adrian Helmut Vogler
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany.
| | - Anna-Lena Stummer
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
| | - Kay-Arne Walther
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
| | - Bernd Wöstmann
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
| | - Peter Rehmann
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
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de Morais DC, Butler S, Santos MJMC. Current Insights on Fiber Posts: A Narrative Review of Laboratory and Clinical Studies. Dent J (Basel) 2023; 11:236. [PMID: 37886921 PMCID: PMC10605739 DOI: 10.3390/dj11100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE The aim of this study was to review the literature related to the clinical performance and laboratory findings regarding fiber posts, as well as the cementation technique employed with their use. MATERIALS AND METHODS A literature search was performed using an electronic database, PubMed/Medline, between 2010 and 2023. The terms used were "intra coronal post, fiber post, post cementation, and post length". Titles and abstracts were initially screened, and a full-text assessment was conducted for those that fulfilled the inclusion criteria. The reference list of the collected papers was also screened for further relevant citations. RESULTS In this work, 135 potentially eligible studies were analyzed. Titles and abstracts of 90 studies followed the inclusion criteria and were selected for a full-text assessment, resulting in 50 studies selected. Moreover, additional studies from relevant citations were included, totaling 57 studies. CONCLUSION According to the laboratory and clinical studies revised, the survival rate between fiber and prefabricated and cast metal posts was similar, and failures were mainly related to the loss of retention. The intra-canal post length of less than two-thirds of the root length presented successful results when ferrule was present. Furthermore, the ferrule increased the longevity of teeth restored with fiber posts. Additionally, the use of a surface treatment protocol for fiber posts and the adhesive cementation technique both contributed to the clinical success and longevity of the intra-canal post.
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Vogler JAH, Billen L, Walther KA, Wöstmann B. Conventional cast vs. CAD/CAM post and core in a fully digital chairside workflow - An in vivo comparative study of accuracy of fit and feasibility of impression taking. J Dent 2023; 136:104638. [PMID: 37506812 DOI: 10.1016/j.jdent.2023.104638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Clinical data for CAD/CAM post and cores (PC) is still scarce, even though developments in digital dentistry have improved dental treatment in many aspects. Therefore, the purpose of this in vivo study was to compare CAD/CAM PC fabricated in a fully digital chairside workflow to conventional cast PC (CPC) according to the accuracy of fit and the impression taking. The null hypothesis was that there is no significant difference between CAD/CAM PC and CPC. METHODS The study was conducted on 30 teeth in 25 patients receiving a CPC during their prosthetic treatment plan. On each tooth a conventional and a digital post impression were taken. Subsequently, one CPC following a conventional and one CAD/CAM PC following a digital workflow were fabricated. Both PC were tried-in intraorally and assessed according to a standardised evaluation sheet. The deviation between the two impression methods was evaluated by superimposing the datasets in a 3D analysis software. Statistical analysis for pairwise comparison was conducted according to Wilcoxon and median test with a significance level of p = 0.05. RESULTS CAD/CAM PC performed significantly better compared to CPC according to accuracy of fit (p = 0.022) and feasibility of impression taking (p < 0.001). The deviation between post impression methods increased from "coronal" to "apical". Between "coronal"/"middle" no significant difference (p = 0.158) was detected, whereas the pairwise comparison between the other measurement categories showed significant differences (p = 0.002, p < 0.001). CONCLUSIONS The null hypothesis was rejected since CAD/CAM PC performed significantly better and the deviation between the post impression methods showed significant differences. CLINICAL SIGNIFICANCE By using intraoral scanners (IOS) teeth can be restored with customised CAD/CAM PC in a single session. Within the limitations of this study the fully digital chairside workflow led to superior accuracy of fit of PC and higher feasibility of impression taking than the conventional workflow for CPC.
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Affiliation(s)
- Jonas Adrian Helmut Vogler
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany.
| | - Louise Billen
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
| | - Kay-Arne Walther
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
| | - Bernd Wöstmann
- Dental Clinic - Department of Prosthodontics, Justus Liebig University, Schlangenzahl 14, Giessen 35392, Germany
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Lin P, Xu Z, Luo Y, Yin L. A digital technique for a prefabricated custom post-and-core restoration. J Prosthet Dent 2023; 130:278-283. [PMID: 34799083 DOI: 10.1016/j.prosdent.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
This technique provides a prefabricated and custom post-and-core to restore endodontically treated teeth to be delivered at the preparation appointment. Cone beam computed tomography (CBCT) is used to extract the post shape from a root canal, and a computer-aided design and computer-aided manufacturing (CAD-CAM) software program is used to design the core. The post and the core are combined and milled before post space preparation. Three-dimensional preparation guides are fabricated and used in post space preparation to ensure that the prefabricated and custom post-and-core fits after the preparation. This technique can save time and reduce the risk of perforation while preparing the root canal.
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Affiliation(s)
- Pingting Lin
- Lecturer, Department of Prosthodontics, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, Fujian, PR China
| | - Zhiqiang Xu
- Deputy Director, Department of digital center, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, Fujian, PR China
| | - Yong Luo
- Researcher, Department of Prosthodontics, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, Fujian, PR China
| | - Lu Yin
- Associate Professor, Department of Prosthodontics, Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Engineering Research Center of Fujian University of Stomatological Biomaterials, Xiamen, Fujian, PR China.
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12
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Rakotoaridina K, Delrieu J, Pages P, Vergé T, Nasr K, Canceill T. Evaluation of Poly(etheretherketone) Post's Mechanical Strength in Comparison with Three Metal-Free Biomaterials: An In Vitro Study. Polymers (Basel) 2023; 15:3583. [PMID: 37688208 PMCID: PMC10489626 DOI: 10.3390/polym15173583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
The thinking about metallic replacement has begun in a global context of reducing metallic alloys' use in odontology. Among the materials proposed for their replacement, poly(etheretherketone) may present interesting properties, especially in removable dentures' frames. The purpose of this study is to evaluate fracture resistance of PEEK posts-and-cores compared to non-metallic CAD/CAM materials and fiber glass posts. Forty extracted maxillary central incisors were prepared to receive posts. Samples were divided into four groups depending on whether they had been reconstructed with LuxaCam® PEEK, Enamic®, Numerys GF® or LuxaPost®. Samples were submitted to an oblique compressive test and results were statistically analyzed with ANOVA and Student's tests (or non-parametric tests depending on the conditions). Glass fiber posts and Numerys GF® reveal a significantly higher fracture resistance than LuxaCam® PEEK and Enamic®. No exclusively dental fracture has been noted for the Enamic group, which significantly distinguishes these samples from the three other groups. In our study, it appears that the conception of posts and cores with hybrid ceramic never conducts to a unique tooth fracture. By weighting the results according to the materials used, our data, obtained for the first time on this type of PEEK block, cannot confirm the possibility of using PEEK for inlay-core conception, excepted for specific cases when the material is considered in a patient presenting allergies or systemic disease contraindicating resin or metal.
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Affiliation(s)
- Kévin Rakotoaridina
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
| | - Julien Delrieu
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
| | - Paul Pages
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
| | - Thierry Vergé
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
| | - Karim Nasr
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
| | - Thibault Canceill
- Département Odontologie, Faculté de Santé, Hôpitaux de Toulouse, Université Paul Sabatier, 3 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
- CNRS UMR 5085, INPT, Faculté de Pharmacie, CIRIMAT, Université Toulouse III Paul Sabatier, 35 Chemin des Maraichers, 31062 Toulouse Cedex 9, France
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Vogler JAH, Lehmann M, Schlenz MA, Zierden K, Rehmann P, Wöstmann B. Survival time of post and cores after recementation: A 16-year retrospective study with special focus on loss of retention. J Dent 2022; 127:104314. [PMID: 36184006 DOI: 10.1016/j.jdent.2022.104314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Numerous studies investigating the survival time of post and cores have found that loss of retention is the most common cause of failure Nevertheless, investigations focusing on decementation, survival after recementation, and the influencing parameters in a large number of patients with long follow-up periods are lacking. Therefore, the aim of this short communication article is the survival analysis of post and cores after recementation and repeated loss of retention. MATERIALS AND METHODS During the observation period (2004-2020), 653 patients received 953 post and cores. From these, 112 post and cores which suffered loss of retention were selected. The patient files were analysed for the following parameters: Type of covering prosthetic restoration, location, type of tooth, luting material, post and core material, bone attachment and therapist. The survival time until loss of retention or repeated decementations after recementation was documented. Survival probability was assessed using Kaplan-Meier and Cox regression analyses. RESULTS The average time until decementation was 13.33 years. The cumulative decementation rate was 11.8%, while in 42.0% of the cases, post and cores showed multiple losses of retention. A significant influence (Kaplan-Meier analysis) was recorded for the type of covering prosthetic restoration, type of tooth, luting material, post and core material and bone attachment. The multifactorial survival analysis (Cox regression) showed a significant influence of patient's age and the type of covering prosthetic restoration. CONCLUSIONS Once decementation occurs, recementation neither guarantees definitive fit nor necessarily predetermines repeated decementations. CLINICAL SIGNIFICANCE Post and cores should be avoided under primary crown-retained removable partial dentures (RPD). If this treatment is inevitable, a continuous follow-up is necessary to check the denture for proper fit to the tissues to prevent overloading on the post and core.
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Affiliation(s)
- Jonas Adrian Helmut Vogler
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany.
| | - Moritz Lehmann
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Maximillane Amelie Schlenz
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Karina Zierden
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Peter Rehmann
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
| | - Bernd Wöstmann
- Justus Liebig University, Dental Clinic - Department of Prosthodontics, Schlangenzahl 14, 35392 Giessen, Germany
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14
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Prakash J, Golgeri MS, Haleem S, Kausher H, Gupta P, Singh P, C. SG. A Comparative Study of Success Rates of Post and Core Treated Anterior and Posterior Teeth Using Cast Metal Posts. Cureus 2022; 14:e30735. [DOI: 10.7759/cureus.30735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
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15
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Nesello R, Silva IA, Bem IAD, Bischoff K, Souza MA, Só MVR, Rosa RAD. Effect of bioceramic root canal sealers on the bond strength of fiber posts cemented with resin cements. Braz Dent J 2022; 33:91-98. [PMID: 35508041 PMCID: PMC9645158 DOI: 10.1590/0103-6440202204529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the influence of calcium silicate-based sealers on
the bond strength of fiber posts using conventional and self-adhesive resin
cement. Sixty single-rooted teeth were selected. The canals were prepared with a
reciprocating instrument 40.06. The roots were randomly distributed in six
groups (n = 10) according to the strategies for root canal filling and fiber
posts cementation: AH Plus/RelyX ARC; AH Plus/RelyX U200; Bio C Sealer/RelyX
ARC; Bio C Sealer/RealyX U200; Sealer Plus BC/RelyX ARC; and Sealer Plus
BC/RelyX U200. The roots were transversally sectioned, and one slice per
post-third was obtained. The push-out test was performed at a crosshead speed of
1mm/min. The failure patterns were described after assessment with a
stereomicroscope with a 10× magnification. Bond strength was calculated and
analyzed using the ANOVA and Tukey test. AH Plus did not influence the bond
strength of fiber posts cemented with conventional (RelyX ARC) or with
self-adhesive resin cement (RelyX U200). The lowest bond strength values were
obtained when calcium silicate-based sealers were associated with conventional
resin cement (Bio C Sealer/RelyX ARC and Sealer Plus BC/RelyX ARC). Except for
Sealer Plus BC/RelyX ARC, all groups presented lower bond strength at the apical
portion compared to the cervical portion of the post. Adhesive failures between
cement and post and cement and dentin were predominant (55.3%). Calcium
silicate-based sealers decreased the bond strength of fiber posts cemented with
conventional resin cement.
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Usta SN, Cömert-Pak B, Karaismailoğlu E, Eymirli A, Deniz-Sungur D. Patterns of Post-Endodontic Restoration: A Nationwide Survey of Dentists in Turkey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031794. [PMID: 35162816 PMCID: PMC8834666 DOI: 10.3390/ijerph19031794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
Developments in materials and techniques, geographical locations, age, specialty, and affiliations of dental practitioners affect the preference of post-endodontic restoration. Thus, this survey aimed to evaluate the trends of dentists in Turkey in terms of post-endodontic restorations. An anonymous survey containing 10 questions regarding demographics, post-endodontic restoration patterns, and factors affecting restoration selection was electronically delivered to the dentists registered in the database of the Turkish Dental Association. The data were analyzed using by a chi-square test and ordinal logistic regression analysis. A total of 1093 surveys from 20,564 participants were collected with a response rate of 5.3%. Half of the participants (52%) preferred composite resins for post-endodontic restorations. Usage of posts was less prevalent amongst prosthodontists and dentists with clinical experience of more than 20 years compared to endodontists (p < 0.001) and dentists with clinical experience of less than 5 years (p = 0.004). More than half of the participants (56%) utilized fiber posts. Composite resins and fiber posts were the most common preferences in post-endodontic restoration. Endodontists had a higher tendency to use posts than prosthodontists and general dental practitioners.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara 06230, Turkey; (B.C.-P.); (A.E.); (D.D.-S.)
- Correspondence:
| | - Begüm Cömert-Pak
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara 06230, Turkey; (B.C.-P.); (A.E.); (D.D.-S.)
| | - Eda Karaismailoğlu
- Department of Medical Informatics, Gulhane Faculty of Medicine, University of Health Sciences, Ankara 06018, Turkey;
| | - Ayhan Eymirli
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara 06230, Turkey; (B.C.-P.); (A.E.); (D.D.-S.)
| | - Derya Deniz-Sungur
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara 06230, Turkey; (B.C.-P.); (A.E.); (D.D.-S.)
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17
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Survival time of post and cores: A 16 year retrospective follow-up study. J Dent 2021; 117:103923. [PMID: 34953973 DOI: 10.1016/j.jdent.2021.103923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The retrospective survival study (1995-2004) by Balkenhol et al.[1] led to changes in the decision-making process for treatment with post and cores (special focus on the covering prosthetic restoration while deciding for treatment with post and cores, high primary friction at the try-in stage for conventional cementation, only indirect fabrication technique, no semi-precious alloy) in our clinic. The aim of this study was to examine the influence of these changes on the survival probability. MATERIALS AND METHODS In the observation period (2004-2020) 653 patients received in total 953 post and cores. The patient files were analysed due to the parameters: Type of covering prosthetic restoration, location, type of tooth, luting material, post and core material, bone attachment, therapist and cause of failure. According to the previous study the survival probability was assessed using Kaplan-Meyer analysis. Cox regression was used to assess the risk of failure and identify possible covariates. RESULTS The average survival time of the post and cores was 10.9 years. The cumulative failure rate was 28.2%. A significant influence on the survival time (Kaplan-Meyer analysis) could be found for the parameters: Type of covering prosthetic restoration, location, type of tooth, post and core material and bone attachment. The multifactorial survival analysis (Cox regression) showed a significant influence of the age of the patient at the time of fitting the post, the type of covering prosthetic restoration and the bone attachment. CONCLUSIONS The changes in the decision-making process did not lead to a better survival probability. CLINICAL SIGNIFICANCE The conclusions stated in the previous study were not strict enough. Treatments with post and cores should be critically scrutinized on the basis of covering prosthetic restoration and bone attachment. Post and cores under primary crown retained RPDs should be avoided because of the bad survival probability.
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18
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Evaluation of the Bonding Strength between Various Dental Zirconia Models and Human Teeth for Dental Posts through In Vitro Aging Tests. COATINGS 2021. [DOI: 10.3390/coatings11091017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In dentistry, root canal treatment reduces support of the tooth, making it necessary to insert a cylindrical body into the treated tooth to strengthen the crown. In the past, metal or fiberglass was often used. However, metal is too different in color from teeth, so the esthetics are poor, and fiberglass is not as strong as metal. Therefore, an alternative is zirconia, which has the characteristics of high light transmittance, esthetics, good biocompatibility, and high breaking strength. The surface morphology and composition of zirconia ceramics are the key to their bond strength with teeth. Therefore, in this study, the surface characteristics of different brands of zirconia commonly used in clinical practice were evaluated in terms of their surface morphology and surface elements. The surface was modified by sandblasting, and its effect on the bonding strength was discussed. Finally, the stability of the material was evaluated through artificial aging. The results showed that the surface roughness of the zirconia specimens increased after sandblasting, whereas the surface microhardness decreased. The shear test results showed that the 3D shape of the zirconia surface could help improve the bonding strength. The bonding strength of DeguDent increased the most after sandblasting. After 20,000 cycles of aging treatment, the shear strength of each specimen decreased. Field emission scanning electron microscopy results showed that the adhesive remained intact on the surface of zirconia, indicating that adhesion failure occurred between the adhesive and the teeth. This confirms that sandblasting can improve the bonding strength of zirconia. Based on the results obtained, it was concluded that the surface roughness of zirconia is the main factor affecting the bond strength.
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Martins MD, Junqueira RB, de Carvalho RF, Lacerda MFLS, Faé DS, Lemos CAA. Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis. J Dent 2021; 112:103750. [PMID: 34274439 DOI: 10.1016/j.jdent.2021.103750] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/04/2021] [Accepted: 07/11/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To evaluate systematically the evidence about the failure rates of endodontically treated teeth (ETT) restored with intraradicular metal posts (MPs) or fiber posts (FPs). DATA The review protocol was registered on PROSPERO (CRD42020189792). Eligibility criteria included randomized clinical trials (RCT) and prospective clinical trials (PCT) that compared the failures between FP and MP restorations for ETT. Meta-analyses were conducted for failure rates using fixed- and random-effects models. Subgroup and funnel plot analyses were performed. SOURCES Four electronic databases (MEDLINE/PubMed, Web of Science, Scopus, and Cochrane Library), manual, and grey literature were screened by two researchers independently for articles published until November 2020 without language or time restrictions. For the analysis of the risk of bias, the Cochrane collaboration tool and ROBINS-I were used. The certainty of the evidence was evaluated using GRADE. STUDY SELECTION Ten studies were included. A total of 704 participants with a mean age of 42.7 years with a total of 844 ETT were restored using 453 FPs and 391 MPs. The FPs presented similar failures to that with MPs (P=0.39; risk ratio [RR]:0.82; 95% confidence interval [CI]: 0.52 to 1.29). Subgroup analysis showed no significant differences between the FPs and MPs for the anterior region (P=0.60; RR:0.88; [CI]: 0.54 to 1.42), posterior region (P=0.52; RR:1.18; [CI]: 0.71 to 1.98), root fracture (P=0.44; RR:0.78; [CI]: 0.41 to 1.49), and debonding (P=0.56; RR:1.27; [CI]: 0.57 to 2.80). Additionally, FP showed similar failures compared with those of cast (P=0.36; RR:0.63; [CI]: 0.23 to 1.72) and prefabricated MPs (P=0.68; RR:0.90; [CI]: 0.54 to 1.50). The RCT and PCT studies revealed a low risk of bias for most of the domains. However, the certainty of evidence was considered low. CONCLUSION No evidence of difference was observed for failure rates between FPs, and MPs, independent of region and different MPs used in ETT. However, further well-conducted clinical studies with high-quality evidence are encouraged. CLINICAL SIGNIFICANCE Our results indicate that both retainer posts can be considered an adequate alternative in restoring ETT. Therefore, the choice of post (fiber or metal) could be based on dentist preference or individual characteristics of the patient as the failure rates for different posts are similar.
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Affiliation(s)
- Marielle Dias Martins
- Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Rafael Binato Junqueira
- Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Rodrigo Furtado de Carvalho
- Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Mariane Floriano Lopes Santos Lacerda
- Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Daniele Sorgatto Faé
- Postgraduate Program in Applied Health Sciences (PPGCAS), Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Cleidiel Aparecido Araujo Lemos
- Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Avançado Governador Valadares, Governador Valadares, Minas Gerais, Brazil.
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Pignataro RRD, Samico RDP, Campaner LM, Bottino MA, Borges ALS, Tribst JPM. Influence of Different Fibreglass Post Geometries on the Stress Distribution and Pull-Out Bond Strength Before and After Mechanical Cycling. Eur Endod J 2021; 6. [PMID: 34047296 PMCID: PMC8461497 DOI: 10.14744/eej.2020.95967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE There are no reports in the literature on whether FGP geometry influences the bond strength of the endodontically restored tooth. This study aimed to determine the stress distribution and the pull-out bond strength of different FGP geometries, before and after chewing loads simulation. METHODS One hundred and twenty root analogues were prepared and randomly distributed in six groups according to the post geometry. Half of the specimens were aged in water at 37 °C using a mechanical fatigue machine (84 N, 2 bar, 45°, 106 cycles, 4 Hz); while the remaining specimens were immediately submitted to the pull-out bond strength test. The specimens were tested in a universal testing machine and the bond strength in MPa was calculated. To assess the stress concentration, the finite element method was used simulating the same post geometries that were used in the in vitro test. RESULTS Two-way ANOVA (95%) showed no influence of post geometry on the bond strength (P=0.055) while fatigue cycling was statistical significant to reduce the bond strength values (P=0.000). The factors interaction was significant (P=0.019); however, TUKEY test (5%) showed no significant difference between post geometries after mechanical cycling. The tensile stress result showed critical areas in the post's cervical region regardless of the design. CONCLUSION The FGP geometry does not affect the root stress distribution and the long-term bond strength. However, FGP that allow a reduced cement layer thickness can improve the immediate pull-out bond strength value.
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Affiliation(s)
- Rossana Reim Del´Gaudio Pignataro
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
| | - Renata de Paula Samico
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
| | - Larissa Mendes Campaner
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
| | - Marco Antonio Bottino
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
| | - Alexandre Luiz Souto Borges
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
| | - João Paulo Mendes Tribst
- From the Department of Dental Materials and Prosthodontics, Institute of Science and Technology, Unesp, São José dos Campos/SP, Brazil
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21
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Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years. J Clin Med 2021; 10:jcm10050908. [PMID: 33669002 PMCID: PMC7956800 DOI: 10.3390/jcm10050908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT). Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made. Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan–Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1–98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68–56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03–23.38)), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205–1.61)). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively). Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.
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22
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Verdum I, Abreu de Bem I, Marks Duarte PH, Machado LS, Pereira JR, Reis Só MV, Abreu da Rosa R. Effect of ultrasonic activation of the adhesive system on dentin tubule penetration and the pushout bond strength of fiber posts. J Prosthet Dent 2020; 127:295-301. [PMID: 33243473 DOI: 10.1016/j.prosdent.2020.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Whether ultrasonic activation of the adhesive system improves dentin tubule penetration and the bond strength of fiber posts to root dentin is unclear. PURPOSE The purpose of this in vitro study was to evaluate the effect of ultrasonic activation of 2 adhesive systems (etch-and-rinse and self-etch) and 1 glass ionomer cement on the dentin tubule penetration and pushout bond strength of fiber posts to root dentin. MATERIAL AND METHODS Sixty maxillary central incisors were endodontically treated and divided into 6 groups (n=10) as per the post cementation strategy: etch-and-rinse, etch-and-rinse and ultrasonic, self-etch, self-etch and ultrasonic, glass ionomer cement, and glass ionomer cement and ultrasonic. The primers, the adhesives, and the glass ionomer cement were activated for 20 seconds each, and the fiber posts were cemented with a resin cement. Dentin tubule penetration was evaluated by confocal laser scanning microscopy and the pushout bond strength measured at 3 post locations: cervical, middle, and apical. The failure patterns were also described after pushout testing. RESULTS Self-etch and ultrasonic showed higher dentin tubule penetration than the other cementation strategies (P<.05) and improved the bond strength values (P<.05), which were higher than etch-and-rinse and ultrasonic and glass ionomer cement and ultrasonic (P<.05). Adhesive failures at the cement and dentin interface were predominant in the etch-and-rinse, self-etch, and self-etch and ultrasonic groups. CONCLUSIONS Ultrasonic activation improved the dentin tubule penetration of a self-etch adhesive system. The bond strength of fiber posts cemented with a self-etch adhesive system and a resin cement was improved after ultrasonic activation.
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Affiliation(s)
- Isabel Verdum
- Graduate student, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Igor Abreu de Bem
- Master student, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Pedro Henrique Marks Duarte
- Doctoral student, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Lucas Silveira Machado
- Assistant Professor, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Jefferson Ricardo Pereira
- Associate Professor, Department of Prosthodontics, School of Dentistry, University of Southern Santa Catarina (UNISUL), Tubarão, Brazil.
| | - Marcus Vinícius Reis Só
- Associate Professor, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu da Rosa
- Assistant Professor, Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
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Longevity and Risk Factors of Post Restorations after up to 15 Years: A Practice-based Study. J Endod 2020; 47:577-584. [PMID: 33091454 DOI: 10.1016/j.joen.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aims of this multicenter, practice-based cohort study were to evaluate the success and survival of endodontically treated teeth with post restorations (ETT+Ps) and to analyze factors associated with the longevity of ETT+Ps. METHODS Eight general dental practitioners each placed up to 27 ETT+Ps without any restriction to post materials or dimensions. Only incisors, canines, and premolars were included. At the last follow-up visit, ETT+Ps were considered as successful if the post and the initially placed definitive restoration were sufficient, whereas ETT+Ps were considered as survived if the post was still in function. Multilevel Cox proportional hazards models were used to evaluate the association between a range of predictors and time until no success and no survival. RESULTS Overall, 195 endodontic posts in 195 patients were followed up for a mean (95% confidence interval) of 91 (81-101) months; the longest follow-up was 15 years. Of these, 122 ETT+Ps were considered successful (estimated success time = 110 [101-120] months), and 152 ETT+Ps survived [estimated survival time = 133 [124-141] months). Regarding the categories of success and survival, the annual failure rates were 6.0% and 3.3%, respectively. Recementation of old (telescopic) crowns after placing new posts was the only significant predictor for decreased time until failure for both success and survival analyses. By excluding recemented restorations, annual failure rates decreased to 3.5% and 2.1%, respectively. CONCLUSIONS For EET+Ps placed in a private practice setting, high success and survival rates were observed. If old (telescopic) crowns were recemented after new posts were placed, the high risk of subsequent failure should be considered and communicated with patients.
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