Cast Metal Core Research Articles

Management of dislodged crown using split cast metal post and core: A case report

Across diverse cultures, the practice of restoring lost tooth structure has endured through generations. It is widely understood that merely undergoing quality endodontic therapy is not sufficient to fully restore a severely weakened tooth with pulpal disease. Equally crucial is ensuring post-endodontic restoration followed by quality prosthetic rehabilitation. In instances where a tooth is extensively damaged, utilizing a post becomes the preferred course of action post endodontic treatment to preserve the core. The gold standard for the treatment of a severely compromised tooth is recognized as a cast post and core. In this case study, a previously treated maxillary first molar, which had a dislodged fiber post and core along with a porcelain-fused-to-metal (PFM) crown, underwent retreatment with a split cast metal post and core followed by a PFM crown.

A case report on the rehabilitation anterior teeth using custom made post and pre fabricated fiber post and core

Posts are recommended to fortify weak, endodontically treated teeth against intra-oral forces by channeling torquing forces through the radicular dentin to supportive tissue along the roots. The subsequent case studies demonstrate an interdisciplinary approach that employed custom cast posts and complete veneer crowns to repair severely damaged treated teeth, restoring both their appearance and functionality. Coordinating prosthetic and endodontic treatments, while carefully considering the patient's expectations and requirements, played a pivotal role in achieving positive outcomes and ensuring patient satisfaction. Traditionally, the cast metal post and core system has been widely used as the foundational restoration for a prosthetic crown, benefiting from a natural extension of the post within the core. The post's function is to bolster the core restoration, which rebuilds the compromised coronal structure. This article explores the utilization of cast post and core systems alongside porcelain-fused-to-metal restorations for addressing injured maxillary central incisors.

Comparative analysis of the biomechanical behavior of the maxillary central incisors restored with glass fiber post and cast metal post and core submitted to orthodontic forces: A study with finite elements

Different types of intraradicular restorations and their insertion have an impact on teeth biomechanics. This study aimed to analyze the biomechanical behavior of maxillary central incisors restored with glass fiber post (GFP) and cast metal post and core (CMP) subjected to buccolingual and mesiodistal orthodontic forces using the finite element method. Two models of the maxillary central incisor with periodontal ligament, cortical bone, and trabecular bone were made. One of the models included intraradicular restoration with GFP, whereas, in the other, the incisor was restored with CMP. After creating the tridimensional mesh of finite elements, applying 2 orthodontic forces were simulated: 65 g of buccolingual force and 70 g of mesiodistal force. The forces were applied parallel to the palatal plane in the region of the bracket slot, located 4 mm to the incisal edge. The maximum stresses generated in the GFP-restored root were 3.642 × 10-1 MPa and 4.755 × 10-1 MPa from the buccolingual and mesiodistal forces, respectively. Likewise, the stresses in the CMP restored root were 2.777 × 10-1MPa and 3.826 × 10-1MPa. The radicular area with higher stress on both models was located in the cervical third: on the buccal surface when the buccolingual force was applied and on the mesial surface when the mesiodistal force was applied. The highest stress levels were found on the CMP structure. The incisor restored with cast metal post revealed lower stress values transferred to the root than the one restored with GFP. The stresses on the structure of the GFP were lower and more homogeneous than the ones found on the cast metal post. The difference among the stress values in the materials is within a safe margin for using both materials in relation to orthodontic forces.

Fracture Resistance and Stress Distribution Pattern of Different Posts-Core Systems in Immature Teeth: An In Vitro Study and 3D Finite Element Analysis.

Introduction Restoration of immature teeth with open apices and thin dentinal walls with conventional post systems remains a challenge. The purpose of this study was to evaluate the fracture resistance of simulated immature teeth restored with different intraradicular posts and assess their stress distribution pattern using 3D Finite Element Analysis (FEA). Methods Fracture strength testing using universal testing machine was carried out in simulated immature teeth restored with different intraradicular posts grouped as follows: Group A: teeth not restored with posts served as control group; Group B: Cast metal post (CMP); Group C: Customized Composite Post (CCP); Group D: Fiber post (FP). Four 3D FEA models of the above groups were created using CATIATM software and analyzed for stress distribution using ANSYSTM. The results of fracture strength testing and FEA were correlated. Multiple group comparisons were analyzed by one-way ANOVA followed by Tukey HSD post hoc test. Results The CMP exhibited highest fracture resistance (336.43 N) but resulted in root fractures. The CCP exhibited lower fracture resistance (240.90 N) and favorable stress distribution as compared to CMP. The FP and control group exhibited lower fracture resistance values of 182.69 N and 130.46 N, respectively. The results of 3D FEA demonstrated higher stress concentration in model comprising metallic post and core. Conclusions Teeth restored with cast metal posts and cores exhibited maximum fracture resistance followed by the customized composite posts, the fiber posts, and the control group. The cast metal posts indicated higher von Mises stresses concentrated in the radicular region; however, the customized composite posts, the fiber posts, and the control group demonstrated stress concentration in the coronal region.

A clinical and radiographic comparative evaluation of treatment outcome of different fiber post systems with conventional cast metal post and core system

A clinical and radiographic comparative evaluation of treatment outcome of different fiber post systems with conventional cast metal post and core system

Alternative conservative approach for tooth build-up in patients with special healthcare needs

Purpose: The success of an artificial crown mainly depends on the biomechanical factors such as bonding capacity of cement between the crown and abutment tooth, and root strength of the abutment tooth. In this case series, we aim to provide insight on the potential use of the cast metal post and cost for patients with intellectual disabilities and severely compromised tooth structure. Material and methods: The first patient was a 41-year old male with the chief complaint of a dislodged porcelain fused metal (PFM) crown of tooth #20 (mandibular left second bicuspid). The patient was informed about the advantages, disadvantages, and risks of each option. After further consideration and discussion with the parents and the patient, we decided to rebuild the coronal tooth structure with the cast metal post and core and prosthetic restoration with the same crown. Patient satisfaction was measured on the visual analog scale as 10/10. The second case involves a 26-year old female, who presented with a chief complaint of chronic lingering pain on tooth #9. The tooth structure was extensively damaged and un-supportive of the ferrule, therefore, it was decided to build a metal post and core instead of a fiber post. The prosthetic restoration was made with a monolithic zirconia crown and the patient was followed up twice in 6 months and graded the satisfaction as 10/10 on a visual analog scale. Results: The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. Conclusions: Both the presented cases explain an interesting advantage of restoring a root canal treated tooth with a metal post and core system which implies that in a prefabricated post and core restored tooth failure, a metal post, and core can potentially be the treatment of choice instead of extracting the tooth. Keywords: post and core; special needs; cast metal post.

Alternative Conservative Approach for Tooth Build-Up in Patients with Special Healthcare Needs

Purpose: The success of an artificial crown mainly depends on the biomechanical factors such as bonding capacity of cement between the crown and abutment tooth, and root strength of the abutment tooth. In this case series, we aim to provide insight on the potential use of the cast metal post and cost for patients with intellectual disabilities and severely compromised tooth structure. Material and Methods: The first patient was a 41-year old male with the chief complaint of a dislodged porcelain fused metal (PFM) crown of tooth #20 (mandibular left second bicuspid). The patient was informed about the advantages, disadvantages, and risks of each option. After further consideration and discussion with the parents and the patient, we decided to rebuild the coronal tooth structure with the cast metal post and core and prosthetic restoration with the same crown. Patient satisfaction was measured on the visual analog scale as 10/10. The second case involves a 26-year old female, who presented with a chief complaint of chronic lingering pain on tooth #9. The tooth structure was extensively damaged and un-supportive of the ferrule, therefore, it was decided to build a metal post and core instead of a fiber post. The prosthetic restoration was made with a monolithic zirconia crown and the patient was followed up twice in 6 months and graded the satisfaction as 10/10 on a visual analog scale. Results: The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. Conclusions: Both the presented cases explain an interesting advantage of restoring a root canal treated tooth with a metal post and core system which implies that in a prefabricated post and core restored tooth failure, a metal post, and core can potentially be the treatment of choice instead of extracting the tooth.

Endodontically treated teeth with custom cast post and core and metal ceramic crowns restoration: A case report

There are various post systems and materials available which is used for restoration of fractured tooth structure of endodontically treated teeth. It is a great challenge for the dentist to decide on which system and material to use for restoration of teeth. The reason to use post is to retain the core that holds the definitive prosthesis. Cast metal post and cores are widely used for restoring endodontically treated teeth with extensive loss of tooth structure and to restore with metal-ceramic crowns. The following case report depicts the restoration of fractured teeth after using custom cast post followed by metal-ceramic crowns.

Comparison of shear stress acting on the severely worn anterior canine restored with 2 different restorations

Aim: To compare fracture resistance of severely destructed mandibular canine under oblique loading restored with Richmond crown verses zirconia endocrown. Materials and method: 10 mandibular canine were endodontically treated and divided into 2 group of 5 each both the group were cut 2mm above the cement enamel junction one group received endo crown and second group received cast metal post and core, both the group were subjected shear force on UTM at cross head speed of 1 mm/min the results obtained were calculated in newton’s and statistical analysis was carried out. Results: Cast metal post and core (972.4±217.51N) showed better resistance to fracture than Richmond crown group (1180.6±168.87N).statistical analysis done using unpaired t test (P value =0.1818) which was which was statistically insignificant. Conclusion: endocrown showed better resistance to fracture from shear forces than cast metal post and core.

Esthetic Dentistry: A case report on metal core concealment approach for endodontically treated maxillary anterior tooth

Aim: To fulfil esthetic restoration demand of a badly mutilated maxillary anterior tooth. Background: The life span of endodontically treated teeth has been extraordinarily upgraded by proceeding with improvements made in endodontic treatment and restorative systems. It has been accounted for that an enormous number of endodontically treated teeth are re-established to their unique function with the utilization of intra-radicular instruments and restorative materials. Over the most recent couple of many years, numerous pre-fabricated post and core systems have been developed. To mask the greyish appearance of oxidized subsurface of metal, an opaque layer of porcelain is required once the casting is done, scilicet is reflective eminently. The biggest advantage is gaining the supremacy of both metal and ceramic in terms of strength and aesthetic, both altogether. Case Description: This article reports a case where endodontic retreatment followed by restoration with a ceramic coated cast post was carried out mainly due to the aesthetic priority of the patient. Conclusion: Ceramic coping is an adjunct treatment modality to hide the blackish hue of cast metal post and core when aesthetic need is a concern. Keywords: Aesthetic restorations, Metal cast post, Post and core, Post endodontic restoration.

Impact of Mechanical Load of Three Post and Core Systems: CAD/CAM-fabricated Glassfiber, Prefabricated Glassfiber Customized with Composite Resin, and Cast Metal Posts and Cores

ABSTRACT Aim and objective This study assessed the fracture resistance and failure mode frequencies in three post and core systems: CAD/CAM-fabricated glassfiber post and core, glassfiber post and core customized with composite resin, and cast metal post and core. Materials and methods After endodontic obturation and the post space preparation, 30 extracted mandibular premolars were distributed into three groups (n = 10): Group GFP: glassfiber post and core customized with composite resin, Group CPC: cast metal, and Group CAD/CAM: CAD/CAM-fabricated glassfiber post and core. All the specimens were luted with RelyX U200 cement, submitted to thermomechanical cycling, and then submitted to a compression test, applied at a 45° angle relative to the long axis of the tooth, until fracture. The fracture resistance data were submitted to ANOVA complemented by the Tukey test and the failure mode data by Fisher's exact test with the Freeman–Halton extension (α = 5%). Results There was no significant difference between the fracture resistance values found for groups CPC and CAD/CAM (p >0.05), and these values were significantly higher than those found for Group GFP (p < 0.05). In respect to failure mode frequencies, Group CAD/CAM had equal frequencies of adhesive and cohesive failures, Group GFP had exclusively cohesive failures in the composite core buildup, and Group CPC had 80% of cohesive failures in dentin vs 20% of adhesive failures (p < 0.001). Conclusion The fracture resistance of CAD/CAM-fabricated glassfiber posts and cores was comparable to that of cast posts and cores, and they were not associated with irreparable root fractures. Therefore, CAD/CAM-fabricated glassfiber posts and cores can be considered an effective method for restoring endodontically treated teeth. Clinical significance CAD/CAM system proved to be a viable alternative to cast posts and cores, since they were less associated with irreparable root fractures. How to cite this article Seckler INB, da Silveira Bueno CE, Kato AS, et al. Impact of Mechanical Load of Three Post and Core Systems: CAD/CAM-fabricated Glassfiber, Prefabricated Glassfiber Customized with Composite Resin, and Cast Metal Posts and Cores. Cons Dent Endod J 2020;5(2):36–41.

Stress Distribution in Maxillary Central Incisors without Ferrules: A Finite Element Analysis of Post and Core Systems

Purpose: The purpose of this study was to identify optimal post and core materials for central incisors without ferrules using three-dimensional finite element analysis and three-point bending tests. Methods: Stress analyses were performed with six models: cast metal post and core (MP), composite resin core alone, straight fiber-reinforced post-composite resin core (FSR), tapered fiber-reinforced post-composite resin core, straight titanium post-composite resin core (TSR), and tapered titanium post-composite resin core (TTR). A 100-N load was applied to the lingual surface at a 45° angle to the long axis of the tooth. Maximum von Mises stress distributions were calculated with finite element analysis software. Five samples each of composite resin, straight fiber-reinforced post, straight titanium post, straight fiber-reinforced post and composite resin, and straight titanium post and composite resin were subjected to three-point bending tests, followed by analysis of variance and Tukey’s multiple comparison test. Results: Stress distribution was optimal on TTR. Maximum von Mises stress on the cervical side of the post was greatest in TSR (693 MPa) and TTR (556 MPa). Maximum stress on the apical side of the post was greatest in MP (110 MPa). Maximum stress in surrounding dentin was lowest in MP (203 MPa) and TTR (250 MPa). Gap distance was smallest in MP (0.09 mm) and largest in FSR (0.26 mm). Mean maximum three-point bending force was lowest in composite resin (26.9 N/mm) and highest in titanium post and composite resin (97.1 N/mm). Titanium post bending strength was consistently greater than that of the fiber-reinforced post (p < 0.01). Conclusion: These results revealed optimal stress distribution and high bending strength with the tapered titanium post and resin combination, suggesting that this combination can most effectively prevent root or post fracture in an anterior tooth without a ferrule.

Retreatment of permanent incisors with fibre and cast metalposts

Retreatment of permanent incisors with fibre and cast metalposts - IJCE- Print ISSN No: - 2581-9534 Online ISSN No:- 2581-8988 Article DOI No:- 10.18231/j.ijce.2020.010, IP Indian Journal of Conservative and Endodontics-IP Indian J Conserv Endod

A 10-Year Follow-Up of Different Intra-Radicular Retainers in Teeth Restored with Zirconia Crowns.

PurposeTo evaluate the survival rate in restored teeth with three different types of retainers prior to the fixing of crowns with zirconia through this retrospective clinical study. It is unclear how the type of post and core rehabilitation, and type of resin cement affect the longevity of teeth restored with crowns.MethodsIn a private clinic, a total of 101 retainers installed by the same professional between June 2008 and January 2018, with an average time of 58.2 months (4.8 years), were analyzed regarding the following factors: survival, cement and failure type. Three types of retainers were used according to the indications found in the literature: filling with Z250 light-cured composite resin, 22 elements; fiberglass post with Z250 light-cured composite resin, 45 elements; and cast metallic core in silver-tin alloy, 34 elements. The retainers were cemented with chemically cured cement, U100, U200, or Panavia F.ResultsData were subjected to Kaplan-Meier analysis (p=0.495). Although the study presented several limitations, no significant differences were observed in the success rates between the types of intra-radicular retainers and the type of cement. The success rates were as follows: metal core, 97.1%; fiberglass post, 95.6%; and filling, 100%. On average, failures occurred at 48.4 months.ConclusionIn view of the results, it is possible to conclude that the different retainers evaluated have similar survival rates.

EVALUATION OF DIFFERENT TYPES OF CROWNS USED FOR RESTORATION OF ENDODONTICALLY TREATED TEETH

Endodontically treated teeth (ETT) have been problematic in most cases as a result of dental caries, fractures, previous restorations and endodontic procedures. Several post system techniques and materials are currently used to build up ETT with moderate or severe loss of coronal tooth structure and to retain final restorations. Following root filling, the custom-made cast metallic post and core with metal-ceramic crowns was the traditional restoration of choice, but this has changed. The patients’ primary motivation for seeking superior dental aesthetics, particularly in the anterior aesthetic zone, has prompted the development of non-metallic restorations. Several new types of polymeric and more aesthetic quartz and glass-fibres posts, combined with direct resin composite cores, provide an aesthetic foundation for an all-ceramic crown and have overcome the aesthetic limitations of metallic posts and cores in the anterior teeth. Until recently, there has been controversy in the dental community regarding which material or technique is the most favourable for the restoration of ETT. It seems that the amount and retentive capacity of the remaining tooth structure, the position of the tooth in the dental arch, the functional or para-functional loading on the tooth, and the treatment plan to restore aesthetics and function all influence the selection of the most appropriate post system for each case. Hence the present study was planned for Evaluation of Different Types of Crowns Used For Restoration Of Endodontically Treated Teeth.&#x0D; The present study was planned in Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, Bihar, India. The 40 cases of maxillary anterior endodontically treated teeth (ETT). The roots were restored with reinforced GFPs (Relaxy Fiber Post, 3M ESPE, Germany), and composite resin cores (Tertic-N-Ceramic, Ivoclar Vivadent, Lichenestine).&#x0D; The survival of ETT is contingent on the residual sound tooth structure that remains after the endodontic access and caries removal are performed consequently the most important factors upon restoring ETT become the maximum preservation and conservation of enamel, dentin and the dentinoenamel junction. Hence, bonded partial restorations are always preferred over full coverage cementable crowns. More clinical studies comparing adhesive crowns bonded to postless build-ups or post and -core build-ups are needed for a better understanding of postless approaches in biomimetic restorative dentistry.&#x0D; Keywords: Endodontically treated teeth, Crown, cores, post, etc.

In Vitro Gap Changes After Porcelain Firing Cycles of Three and Four Unit of CAD/CAM Milling, Laser Sintering and Cast Metal Ceramic Restorations

Objectives: Marginal adaptation changes during the veneering process is an important factor in the clinical success of metal framework techniques such as conventional cast metal cores (LW), CAD-CAM Metal Milling (MM) and Direct Metal Laser Sintering (DMLS). The aim of this study is to evaluate the marginal fit changes between three- and four- unit’s metal ceramic fixed partial dentures (FPD’s) fabricated by Lost Wax (LW), CAM Metal Milling (MM) and (Direct Metal Laser Sintering) DMLS metal framework techniques after porcelain firing cycles (PFC).Methods: A total of 60 stainless steel three and four unit FPD’s models were fabricated. Specimens were randomly divided into three groups to fabricate metal ceramic FPD’s frameworks with LW, MM and DMLS techniques. Before and after PFC, cross-sections from silicone replicas were obtained, sectioned, examined and measured with a light microscope. The statistical analysis was done with Mann-Whitney U and Kruskal Wallis and Wilcoxon Signed Ranks tests. Results were evaluated at 95 % of confidence interval and p&amp;lt;0.05 level.Results: There was a statistically significant difference between the three and four unit of FPD’s, before PFC for LW and MM (p:0.000) and DMLS (p:0.019)’s groups and only DMLS (p:0.006)’s group was statistically significant after PFC. The mean marginal gaps of LW technique was higher than the MM and DMLS’s techniques before PFC. After PFC, DMLS’s technique results were higher than LW and MM technique but, no statistically significant difference was found between the marginal gap values of the three and neither for four units of DMLS’s FPD’s.Conclusion: PFC decreases the mean marginal gap of the LW and MM group, but, there was a slight increase for DMLS group. However, all the marginal gap values obtained were in clinical acceptance level for three and four-units FPD’s for all tested specimens.

In Vitro Fracture Resistance and Bond Strength of Self-Adhesively Luted Cast Metal and Fiber-Reinforced Composite Posts and Cores: Influence of Ferrule and Storage Time.

To evaluate the fracture resistance and bond strength of cast posts and cores (CPCs) and customized glass fiber posts (CFPs) with self-adhesive luting. A total of 56 recently extracted premolars were divided into four groups for the fracture resistance test (CPC and CFP, with and without ferrule) and four groups for the bond strength test (CPC and CFP, immediate and 6 months of storage). Differences for fracture resistance were found between CPCs and CFPs with ferrule. For bond strength, the interaction between post and root region was significant. Self-adhesive luting increased fracture resistance of CPCs with ferrule. The ferrule decreased root fractures. Bond strength was similar for both retainers but not for the apical third. Water storage affected bond strength positively.

Stress distribution in dental roots restored with different post and core materials

Aim: The aim of this study was to investigate the stress distribution in models of maxillary central incisors restored with different post and core systems. Materials and Methods: A finite-element model of a maxillary central incisor was simulated in four different configurations – model 1: an intact tooth, Model 2: received gold cast metallic post and core, Model 3: received a fiberglass post and core, and Model 4: had a fiberglass post and the composite resin core. The restored tooth models were assumed to receive a ceramic crown simulating a clinical situation. After the preparation, the geometric models were exported in mesh to the analysis software (ANSYS 10.0, ANSYS Inc., Houston, USA). A 100 N static force at a 130° angle with respect to the longitudinal axis of the tooth was applied to the palatine surface of the model along equally distributed on the element nodes. The values and stress distribution were analyzed. Results: The stress distribution in the radicular structure of the models restored with three different post and core systems was like each other, but the gold cast metallic post and core system slightly improved the pattern of the stress distribution. Conclusions: The placement of post changes the stress distribution behavior, and the material with the highest elastic modulus showed the best performance in the stress distribution.

Aesthetic solution for ceramic restoration on cast metal core

Introduction: In order to satisfy the aesthetic desires of the population, by masking the restorations was the search for the evolution of restorative materials enabling the introduction of metal-free materials. But previous studies that have been made with metal structures often cannot be removed and therefore require devices that can be masked, because there is no desire for a total passage of light avoiding dim reflection of these funds. For these situations, you must opt for a ceramic system to provide a degree of opacity, without losing its characteristics of light transmission, reflectance and saturation. Case report: In case the patient had clinical a metal ceramic crown on the molten core element 21, it was confirmed radiographically the core could not be removed because it would fracture risk to the tooth. We chose to use an opaquer ceramic framework to prevent the passage of light over dark metal. The material of choice was zirconia ceramic by high flexural strength, allowing it to function as a framework for crowns. Conclusion: With the correct application of ceramic coverage on Caqueta noted that it is possible to mask the gray color of the metal through the knowledge of the optical material, the correct use of these properties, opacity and translucidus, and a close contact between dentists and prosthetic.

The effect of conventional, half-digital, and full-digital fabrication techniques on the retention and apical gap of post and core restorations

Statement of problemConventional cast metal posts and cores are fabricated using direct and indirect techniques, both of which need impression materials and considerable laboratory work. Digital techniques have the capacity to substitute for conventional methods in fabricating the posts and cores. However, the accuracy of restorations resulting from a digital workflow is unknown. PurposeThe purpose of this in vitro study was to compare the retention of posts and cores fabricated using full-digital, half-digital, and conventional techniques and to define the accuracy of each technique in terms of the apical gap. Method and materialsThirty newly extracted mandibular first and second premolar teeth were selected for this in vitro study. Impressions were made using direct acrylic resin patterns (conventional), indirect silicone impressions of the intracanal which scanned with a 3Shape laboratory scanner (half digital), and intracanal scan posts captured with an intraoral 3Shape scanner (full digital). Casting and milling were conducted for the conventional impression and digital scans. The obtained posts were cemented using zinc phosphate cement. A universal pullout test was used to measure retention at a crosshead speed of 0.5 mm/min. The apical gap of each post in the canals was defined with parallel digital radiography. The data were analyzed using the Kruskal-Wallis test (α=.05) and Mann-Whitney test at the adjusted α=.016. ResultsSignificant differences were found among the conventional, full-digital, and half-digital techniques in terms of the apical gap (0.11, 0.29, and 0.66 mm; P<.001) and retention (171.6 ±1.9, 107.1 ±5.6 and 91.8 ±6.6 N; P<.001). The correlation between gap and retention in conventional (P=.43), full-digital (P=.09), and half-digital techniques (P=.06) was not statistically significantly different. ConclusionsThe conventional technique was more accurate and resulted in higher retention than both the full- and half-digital techniques. However, the retention and gap of all the posts fell within clinical guidelines.