Abstract
The aim of this systematic review was to compare the clinical performance and failure modes of teeth restored with intra-radicular retainers. A search was performed on PubMed/Medline, Central and ClinicalTrials databases for randomized clinical trials comparing clinical behavior and failures of at least two types of retainers. From 341 detected papers, 16 were selected for full-text analysis, of which 9 met the eligibility criteria. A manual search added 2 more studies, totalizing 11 studies that were included in this review. Evaluated retainers were fiber (prefabricated and customized) and metal (prefabricated and cast) posts, and follow-up ranged from 6 months to 10 years. Most studies showed good clinical behavior for evaluated intra-radicular retainers. Reported survival rates varied from 71 to 100% for fiber posts and 50 to 97.1% for metal posts. Studies found no difference in the survival among different metal posts and most studies found no difference between fiber and metal posts. Two studies also showed that remaining dentine height, number of walls and ferrule increased the longevity of the restored teeth. Failures of fiber posts were mainly due to post loss of retention, while metal post failures were mostly related to root fracture, post fracture and crown and/or post loss of retention. In conclusion, metal and fiber posts present similar clinical behavior at short to medium term follow-up. Remaining dental structure and ferrule increase the survival of restored pulpless teeth. Studies with longer follow-up are needed.
Highlights
Endodontically-treated teeth commonly present great coronal loss due to caries, fractures or access methods for the endodontic treatment
Selection of the most suitable post system is challenging since complex factors, such as the tooth position on the arch, quantity of remaining dental structure, presence of contact points, and type of restoration to be placed
Search strategy Medline via PubMed, Cochrane Central Register of Controlled Trials (Central) and ClinicalTrials.gov databases were searched for randomized clinical trials reporting clinical performance and failure modes of intra-radicular posts through July 2016, placing no limit on the publication year
Summary
Endodontically-treated teeth commonly present great coronal loss due to caries, fractures or access methods for the endodontic treatment. For the reconstruction of endodontically-treated teeth with extensive coronal destruction, intra-radicular posts are recommended to retain the definitive crown restoration[1] and minimize stress transfer to the tooth,[2] since non-vital teeth are more prone to fractures than vital teeth.[3] intra-canal anchorage does not strengthen the remaining dental structure.[1]. Must be analyzed.[4,5] Traditionally, cast posts and cores have been successfully used for restoration of pulpless teeth. A disadvantage of their use is that additional amount of dentine is removed during tooth preparation.[1,6] posts that are more rigid (higher modulus of elasticity) than dentin, such as cast posts and cores, prefabricated zirconium, or prefabricated metal posts may increase the risk of unfavorable failures. Fiber posts are an alternative since they have mechanical properties similar to the dental structure and so generate a more uniform stress distribution to the root, reducing the risk of catastrophic failure.[2,7]
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