Abstract
To measure tooth volume change before and after post removal using micro-CT and to compare the difference among various combinations of prefabricated post and cement systems. Forty-eight extracted maxillary anterior teeth and mandibular canines were sectioned 13 mm from the apex. Root canals were properly instrumented. Preparations were filled with gutta percha using lateral condensation. Post space was prepared with a touch and heat device, leaving 5 mm of gutta percha from the apex. Specimens were scanned with micro-CT to establish objective baseline volume and divided into two groups of post systems: stainless steel (SS) ParaPost and glass-fiber reinforced composite (FRC) post. Half the posts for each group were cemented with Ketac Cem radiopaque glass-ionomer cement, and the other half with SpeedCEM dual-curing resin cement. The posts and residual cement were removed by the same operator, using the ultrasonic vibration technique under an endodontic operating microscope. The remaining tooth root structure was scanned again using micro-CT with volume reported (mm3 ). The statistical difference between the combination of posts and cements was measured using the Kruskal-Wallis ANOVA test (α = 0.001). The independent variables were evaluated separately using post hoc Tukey examination to determine which groups resulted in a statistically significant difference. There was a statistical difference of tooth root volume change among the groups. Post hoc exam revealed a statistically significant difference in tooth root volume change between group 1 (SS + GI) and the other groups (α = 0.0002). Compared to other post and cement combinations, serrated parallel-sided SS posts cemented with GI cement had the most tooth root structure loss upon post removal using the ultrasonic vibration technique.
Highlights
Understanding how much tooth structure is removed based on type of post and cement will help in selecting future therapy for a root canal treated tooth and determine which combination of prefabricated post materials and cement materials should be used in selected cases
More tooth structure loss was observed in removal of serrated parallel-sided SS posts cemented with GI than other post and cement combinations
The ease of post removal need to be evaluated before choosing future therapy for a patient who presents with failed primary endodontic therapy
Summary
A. Background Failures of initial root canal treatment may occur due to complex root canal systems, lack of healing from persistent intraradicular infection or extraradicular causes such as foreign objects (Torbinejad et al, 2009). Root canal treated teeth with persistent periapical lesions may be treated with nonsurgical retreatment or endodontic surgery. Studies showed that nonsurgical retreatment of previously root canal treated teeth results in higher long-term success rate than that of periapical surgery (Torbinejad et al, 2009). The treatment decision is complicated when a post is present. Posts are used to retain the core when extensive tooth structure is missing. Posts can be drilled, pulled and/or vibrated out. The most critical factor for long term success of a tooth is the amount of remaining tooth structure, the process of post removal inevitably involve tooth structure removal
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