Fracture Resistance of Three Post Types in the Restoration of Anterior Primary Teeth

Evaluation of the Effects of Different Types of Resin Cement Systems on the Push-Out Bond Strength of the Fiber Post to Intracanal Dentin in Anterior Primary Teeth

Background

This study aimed to evaluate the effects of using three different resin cements on push-out bond strength (PBS) of fiber posts to root canal dentin of primary teeth.

Methods

Fifty primary canines were randomly divided into five experimental groups according to the type of the luting agent used for fiber post cementation after endodontic treatment and post space preparation as the following: Group 1: glass ionomer cement (GIC), Group 2: flowable resin composite, Group 3: etch and rinse (E&R) resin cement, Group 4: self-etch (SE) resin cement, Group 5: self-adhesive (SA) resin cement. The PBS values of the cemented fiber posts to root canals were measured. The data were statistically analyzed using a one-way analysis of variance, followed by Tukey's post hoc test.

Results

The highest mean PBS value was observed in Group 4 (SE resin cement), followed by Group 3 (E&R resin cement), and the lowest PBS value belonged to Group 1 (GIC), followed by Group 5 (p-values < 0.05). The mean PBS of Group 3 (E&R resin cement) was significantly higher than those of Groups 1 (GIC), 2 (flowable resin composite), and 5 (SA resin cement) (p-values < 0.05). However, no significant difference was found between the mean PBS of GIC and SA resin cement (p-value >0/05).

Conclusion

Using SE resin cement for fiber post cementation in primary anterior teeth showed the best results, followed by E&R resin cement. The lowest PBS was observed for GIC, followed by SA resin cement.

Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis

Background

Intracanal posts are commonly used to restore lost permanent/primary tooth structure and the smile of the patient.

Aim

This systematic review aims to evaluate the clinical success of intracanal posts used in primary maxillary anterior teeth and compare their mechanical properties.

Methods

An extensive literature search was performed using Medline via PubMed, Embase via embase.com, LILACS, CINAHL via EBSCO, Cochrane Oral Health Group Specialized Register, Scopus, and Web of Science until December 2021 and was updated till December 2022. In vivo and in vitro studies in the English language that assessed clinical success and mechanical properties were included. Distiller SR software was used for everything from title screening to data extraction.

Results

A total of 30 studies were analyzed, including 11 in vivo and 19 in vitro studies. Four studies were included in a meta-analysis, and all 30 studies qualified for qualitative analysis. The meta-analysis showed that fiber posts are clinically superior to composite resin posts (CRPs) (p = 0.02). No significant difference was observed between the fracture resistance of CRPs and no posts (p = 0.73). Most of the included studies showed a high risk of bias.

Conclusion

Conclusive evidence about the effectiveness of various intracanal posts cannot be established. This is due to the limited number of clinical trials and included studies of low to moderate quality with a high risk of bias. To validate the use of posts in primary maxillary anterior teeth, further research, including randomized controlled trials (RCTs) of higher quality, is required.

Clinical significance

The use of intracanal posts in primary teeth is a commonly used treatment modality among pediatric dentists. However, the quality of the evidence to support its use is low. This systematic review provides a comprehensive summary of the current literature and highlights the need for further research. Results were interpreted with caution, as the evidence supporting the use of intracanal posts in primary teeth is limited.

How to cite this article

Shanmugam Y, Raghu A, Muthu MS, et al. Mechanical Properties and Clinical Success of Intracanal Posts in Primary Maxillary Anterior Teeth: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2023;16(S-3):S293-S305.

Comparison of the Pull-Out Resistance of Grossly Decayed Primary Anterior Teeth Restored With Two Different Intracanal Posts: An In Vitro Study

Background Severely damaged primary anterior teeth that require pulp therapy present a high risk of failure due to the loss of tooth substance, resulting from pre-existing decay and endodontic therapy. The ideal post material should have physical and mechanical properties similar to those of dentin. Another concern in restoring endodontically treated primary teeth is the need to find a material that can resorb similar to the natural tooth structure as a part of the exfoliation process, allowing normal eruption of permanent successors. Accordingly, there is no such material other than dentin itself. The introduction of biological dentin posts offers an excellent alternative for restoring such teeth. This study aimed to assess the effect of using dentin posts on the pull-out resistance of endodontically treated primary anterior teeth in comparison to glass fiber posts. Methodology A sample of 30 primary anterior teeth was collected from the outpatient clinic of the Pediatric Dentistry Department, Faculty of Dentistry, Damascus University. A total of 15 freshly extracted permanent teeth with single roots were also collected from the outpatient clinic of the Maxillofacial Surgery Department, Faculty of Dentistry, Damascus University. The roots of the permanent teeth were used to prepare 30 dentin posts using a CAD-CAM machine. After receiving proper endodontic treatment, the primary teeth were divided into two groups (15 teeth in each group). The first group was restored with dentin posts, and the second was restored with glass fiber posts, with the posts measuring 3 mm in length for both groups. Pull-out resistance testing was performed using a Testometric machine. Results The arithmetic mean of the forces applied in the glass fiber posts group was 153.2 ± 39.12 N, while the arithmetic mean of the forces applied in the dentin posts group was 156.7 ± 39.78 N. The data were analyzed at a 95% confidence interval using the independent Student's t-test. There were no statistically significant differences in pull-out resistance between the two groups. Conclusions Dentin posts showed a little increase in pull-out resistance than glass fiber posts. Therefore, the use of dentin posts as intracanal retention in primary anterior teeth is a successful alternative for composite posts.

Comparing the Fracture Resistance of Dentine Posts and Glass Fiber Posts in Primary Maxillary Incisors: An In Vitro Study

Background/purpose An ideal post material should have physical and mechanical properties similar to dentin. Another problem when restoring primary teeth that have undergone root canal treatment is the availability of materials that are resorbed in the exfoliation process in a manner similar to the structure of the natural tooth, allowing the normal eruption of a permanent tooth. This study aimed to evaluate the effect of using dentine posts on the fracture resistance of endodontically treated primary incisors in comparison to glass fiber posts. Materials and methods The study sample consisted of 30 extracted primary maxillary incisors that were randomly distributed into the following two groups: group I (experimental, n=15), which was restored with dentine posts; and group II (control, n=15), which was restored with glass fiber posts. Initially, 10 extracted single-root permanent teeth were collected to prepare 20 dentine posts using a computer-aided design-computer-aided manufacturing (CAD-CAM) machine. Then, the crowns of maxillary primary incisors were cut and the canals were prepared and filled. Then the preparation for a post was made using Gates Glidden drills, and the posts were placed with an extension of 3 mm within the canal in both groups, then the crown was built and the teeth were placed within acrylic cubes and subjected to 500 thermocycling. Fracture resistance was recorded using a Testometric machine (Rochdale, England: Testometric Co. Ltd.). Data were analyzed using an independent Student's t-test. Results The dentine posts group showed greater fracture resistance (246.3 N) than the glass fiber posts group (206.3 N). A statistically significant difference (p=0.004) was found between the two groups in favor of the dentine posts group. Conclusion Based on this in vitro study, the dentin posts used in restoring severely decayed primary maxillary incisors showed greater fracture resistance than glass fiber posts. Therefore, the use of dentin posts as intra-canal stabilizers in maxillary primary incisors is a good alternative for glass fiber posts.

In Vitro Comparison of Fracture Resistance of Severely Damaged Primary Anterior Teeth Restored with Different Post and Core Systems

Objectives

This study aimed to compare the fracture resistance (FR) of severely damaged primary anterior teeth restored with five different post and core systems.

Materials and Methods

This in vitro, experimental study evaluated 60 extracted primary maxillary central incisors. The teeth were horizontally sectioned at 1 mm above their cementoenamel junction (CEJ), underwent pulpectomy, and their root canals were filled with Metapex paste. After post space preparation and sealing of root fillings with light-cure glass ionomer (1 mm thickness), the teeth were randomly assigned to five groups (n = 12) of (1) glass fiber post and everX composite (reinforced with short fibers), (2) glass fiber post and bulk-fill composite, (3) everX composite post and core, (4) bulk-fill composite post and core, and (5) Filtek conventional composite post and core. The teeth underwent 5,000 thermal cycles between 5°C and 55°C, and their FR was measured in a universal testing machine (0.5 mm/min, 148°). The mode of failure was also determined. Data were analyzed by ANOVA and Tukey's test at 0.05 level of significance.

Results

The FR was the highest in fiber post and everX composite, and the lowest in Z250 conventional composite post and core group (P < 0.001). The FR of fiber post and everX composite group was significantly higher than that of everX composite post and core (P = 0.04), bulk-fill composite post and core (P = 0.001), and Z250 composite post and core (P < 0.001) groups. The frequency of repairable fractures was the highest in glass fiber post plus everX composite (91.66%) and the lowest in Filtek conventional post and core group (66.66%) (P > 0.05).

Conclusion

Within the limitations of this in vitro study, the results showed that restoration of severely damaged primary maxillary central incisors with glass fiber post and everX composite reinforced with short fibers enhanced their FR, and increased the chance of reparability in case of restoration fracture. This technique may be recommended for the restoration of primary anterior teeth since it is simple and saves time.

Reconstruction of Pulpotomized Primary Molar and Retention of Stainless-steel Crowns: An In-vitro Study

Background:

Stainless steel crowns are proposed to restore severely decayed teeth in pediatric dentistry. Yet, their retention is still debatable.

Objective:

This study aimed to investigate whether dental tissue reconstruction before placement of stainless steel crown on pulpotomized first primary molar affects the retention of stainless steel crowns.

Methods:

This experimental in-vitro study was performed on 30 extracted first primary molars with carious occlusal and distal surfaces. Dental caries and the pulp chamber roof were respectively removed. The stainless steel crowns were placed after tooth preparation. The samples were randomly divided into two groups (n=15) i.e, ZoE core buildup, and ZoE liner. Stainless steel crowns were cemented with self-curing glass ionomer cement. The crown retention was tested with the Instron testing machine. The two groups were compared by using SPSS software through the t-test (α=0.05).

Results:

The mean crown retention in the liner group (291.45±43.196 N) was significantly higher than that of the core buildup group (202.00±63.515 N) (P=0.001).

Conclusion:

Based on the results of this study for restoring the teeth with extensive tissue loss by SSC, ZoE should be used as lining without a core on teeth.