Endodontic Posts Research Articles

Longevity and Risk Factors of Post Restorations after up to 15 Years: A Practice-based Study

IntroductionThe 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. MethodsEight 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. ResultsOverall, 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. ConclusionsFor 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.

Esthetic and Prosthetic Rehabilitation of Maxillary Lateral Incisor:A Case Report

The key factors in achieving successful outcomes after implant placement immediately after tooth extraction is a correct diagnosis and treatment planning. The efficacy of immediate implant placement has been established and shown to be predictable if reasonable guidelines are followed. The reasons for tooth extraction may include but not limit to: insufficient crown to root ratios, remaining root length, periodontal attachment levels, periodontal health of teeth adjacent to the proposed implant sites, unrestorable caries, root fractures with large endodontic posts and questionable teeth in need of endodontic retreatment. The most esthetically challenging in implant placement is the maxillary anterior region. The reason being that tooth loss leads to resorption of bone and collapse in gingival architecture leading to esthetic compromise and inadequate bone for implant placement. Also, the advantages of placing Immediate implant into freshly extracted socket reduces the treatment time, cost, and increases the patient comfort. This case report describes the procedure for immediate implant placement in fresh extraction socket. Clinical and radiographic examination revealed width and length of the tooth for selecting implant size and design. Implant was successfully loaded and was functional during 24 months follow up period.

The use of endodontic posts in odontal restorations of non-vital teeth

The use of endodontic posts in odontal restorations of non-vital teeth

Image-based study of marginal bone loss in teeth restored with cast endodontic posts

ABSTRACT The aim of this study was to assess marginal bone loss in teeth restored with endodontic posts on all four aspects of the teeth using cone beam tomography. Bone loss was assessed via scores (0-5) in relation to root length and bone height. The results showed that the scores for the contralateral and restored sides, respectively, ranged from 0 to 3 and 0 to 5 buccally, 0 to 4 and 0 to 4 palatally, 0 to 3 and 0 and 4 mesially and 0 to 3 and 0 to 4 distally. A significant difference in bone loss was observed between the post-restored teeth and their contralaterals for the buccal, lingual/palatal and mesial aspects (p<0.05), with teeth bearing endodontic posts scoring highest. In conclusion, marginal bone loss was higher in teeth restored with intra-canal posts when compared to their sound contralaterals.

Success and survival of post-restorations: six-year results of a prospective observational practice-based clinical study.

This prospective, noninterventional, multi-centre, practice-based study aimed to evaluate the longevity of endodontically treated teeth (ETT) restored with posts and to analyse factors influencing the success and survival of endodontic posts. Eight general dental practitioners each placed up to 27 endodontic posts without any restriction to size and material. Teeth were restricted to incisors, canines and premolars. Multi-level Cox proportional hazards models were used to evaluate the association between clinical factors and time until failure. A total of 195 endodontic posts were followed-up for up to 6.5years in 195 patients. Of these, 140 posts were judged as successful [mean success time: 59 (55-63) months]; the mean annual failure rate was 8.6%. This decreased to 4.4% when excluding recementations. 152 posts survived [mean survival time: 64 (60-67) months]. Recemented restorations had an eight times higher failure rate compared with new restorations. Furthermore, restorations with glass fibre post had a significantly lower success rate compared with titanium posts. Relatively low success and survival rates occurred for restorations with posts after root canal treatment in a private practice setting after a follow-up of up to 6.5years. Recemented crowns had a high risk of failure.

Impact of endodontic post material on longitudinal changes in interproximal bone level: a randomized controlled pilot trial.

Aim was to evaluate the impact of glass fiber versus titanium endodontic posts on the interproximal bone level around severely damaged endodontically treated teeth. Thirty-eight participants of a randomized controlled trial on glass fiber (n = 18) and titanium post-endodontic restorations (n = 20) received radiographs at two different times after post placement (T0 = <12months and T1 = 36-72months after post placement). A total of 76 radiographs were analyzed with an image-editing software. Medians of changes in mesial and distal interproximal bone level (∆MBL, ∆DBL) were calculated and tested for statistical significance with respect to post material using Mann-Whitney U test (p < 0.05). Impact of post material on bone level changes was assessed in multilevel mixed-effect linear regression models. The mean observation period was 54months for glass fiber and 50months for titanium posts. Interproximal bone loss was small in both groups during the study period with no significant differences between groups (glass-fiber group, ∆MBL = - 0.03mm and ∆DBL = - 0.06mm; titanium group, ∆MBL = - 0.07mm and ∆DBL = - 0.17mm; both p > 0.05). Overall, impact of post material on bone loss was almost negligible with a nonsignificant difference between materials of 0.10mm during the entire study period. The rigidity of endodontic post material has no impact on the level of alveolar bone support of severely damaged endodontically treated teeth. Post-endodontic restorations of severely damaged teeth can achieve steady levels of periodontal bone support as a parameter of periodontal health, irrespective of post material.

Postendodontic Restoration: Endodontic Post-and-Core or No Post At All?

The objective of this systematic review was to assess the impact of endodontic post insertion on the clinical performance of endodontically treated teeth (ETT). A specific PICO question was developed and a Medline search was performed in January 2017 using relevant terms in order to identify studies comparing the success/survival of dental restorations using endodontic posts or no posts. Additionally, the electronic databases "Opengrey", "BBO", "LILAC" and "IBECS" were assessed and a hand search of cross references from original articles and reviews was performed. The methodological quality of the included studies was assessed independently by three referees using (1) the critical appraisal skills program (CASP) and (2) Cochrane checklist (version 5.1.0). A total of 14 studies were included, among them 11 randomized controlled trials (RCT), two prospective clinical trials, and one retrospective clinical trial. The overall quality of the studies was good according to the CASP. However, the Cochrane rating showed that in seven studies, the risk of bias was high in > 40% of the items, indicating a relevant level of methodological flaws. Three studies showed a low risk of bias in > 80% of the items. The majority (10 out of 14) of the clinical studies included failed to show a positive effect of post placement. A post effect is possible when no cavity wall is present. There is no unequivocal clinical evidence to support or reject the use of posts even for no-wall cavities, either for direct or indirect restorations.

Clinical tips for durable dentin bonding

Adhesion to dental substrate is the key foundation for modern esthetic dentistry that enables practitioners using of tooth colored direct and indirect resins and ceramic based restorations. At their foundation, direct anterior and posterior resin composites, endodontic posts, resin cores, and laboratory processed resin and ceramic veneers, inlays, onlays and crowns all have bonding agents that function as the bridge between the restorative material or luting cement and tooth structure. To achieve clinical success with such restorations, good adhesion between restorative materials and tooth substrates is of crucial importance in order to ensure good marginal sealing, reinforcement of the tooth structure, and longer life of the restoration. During the last two decades, great advances in adhesive dentistry achieved forming what is called by “bonding revolution” in order to produce good adhesion to dental substrates. Modern adhesive systems seem superficially simple-merely a film to be painted on the tooth. Actually, they are often sophisticated and complicated chemical systems that have the challenge of sensitivity to the heroic oral environment where placed, so careful attention to appropriate use and good clinical technique is essential for getting the best performance out of the bonding system and ultimately, the restoration. The presentation will address clinical manipulative tips for obtaining the highest performances, in terms of bond durability and stability of the adhesive interface using these adhesive systems starting from selecting the appropriate system, application tips, common manipulative errors and detecting possible failures.

Influence of Post Angulation between Coronal and Radicular Segment on the Fracture Resistance of Endodontically Treated Teeth.

The objectives of coronal restoration in the Endodontically Treated Teeth (ETT) include rehabilitation of aesthetics, function and prevention of coronal leakage. The long axis of root and the coronal segment in the maxillary anterior teeth varies according to the occlusal scheme. The restorative dentist is required to fabricate the post angulation in compatibility to contour of the adjacent teeth. To evaluate the influence of the angle between the long axes of core facial surface and the radicular segment of the post on fracture resistance of ETT. Total of 30 maxillary intact canines was root canal treated, sectioned 2 mm above the CEJ. The custom made nickel-chromium endodontic posts were fabricated using direct method. The samples were divided among three groups of 10 each. The angle between coronal segment and radicular segment of post in Group-I, Group-II, Group-III were 5°, 10° and 15° respectively. The teeth samples were cemented with full veneer metal crown and tested under universal testing machine. The static load at the angle of 130° was applied until the fracture to record the fracture strength. The obtained data was statistically analysed with ANOVA and Tukey post-hoc test. The Group-III showed the highest fracture strength with 666.15 N. The Group-II and Group-I recorded the mean fracture strength at 443.37 N and 276.74 N respectively. The endodontic post with higher angle between the long axis of facial surface and radicular segment long axis had the positive correlation to the fracture strength in ETT.

Currently used systems of dental posts for endodontic treatment

An advanced stage of a tooth decay promotes an extremely damaged tooth that needs endodontic treatment to be restored. When satisfactory coronal tooth structure remains, an artificial crown can be placed without a post. On the other hand, the treatment of seriously damaged teeth often require an endodontic post. The main reason for using post is to enable rebuilding of the tooth structure prior to crown restoration. Dentists believe that endodontic posts provide a stable and solid restoration of the tooth, as well as providing strengthening of the tooth root, which constitutes the solid basis for a dental crown restoration. However, some authors reported that the strength of the tooth is directly related to the remaining dentin, and because of that, an endodontic treatment can present a higher risk of biomechanical failure. A number of different materials have been used for the manufacturing of dental posts. The fundamental posts requirements include high tensile strength, high fatigue resistance to occlusal and shear loading and a good distribution of the forces affecting the tooth root. The purpose of this article is to review the current literature and identify the various characteristics of a dental post, as well as some principles on the endodontic treatment for tooth decay.

Effect of fiber posts on the fracture resistance of maxillary central incisors with Class III restorations: An in vitro study

Statement of problemEndodontically treated teeth with Class III restorations show reduced fracture resistance. The placement of glass fiber posts may affect fracture resistance and should be further evaluated. PurposeThe purpose of this in vitro study was to evaluate the effect of fiber posts on the fracture resistance of endodontically treated maxillary central incisors with Class III restorations. Material and methodsForty extracted human maxillary central incisors were selected and divided into 4 test groups (n=10 each) according to the restoration strategy: control group; endodontically treated teeth without endodontic posts (GHT); endodontically treated teeth with 2 Class III restorations simulating coronal destruction (GCT); endodontically treated teeth with 2 Class III restorations and a carbon fiber post (GCF); and endodontically treated teeth with 2 Class III restorations and a glass-fiber post (GGF). The fiber posts were adhesively cemented with composite resin cement, and the cavities were restored with composite resin. After 3 months of water storage, all specimens were loaded at 45 degrees in a universal testing machine until fracture and evaluated for fracture mode. The data were analyzed using 1-way ANOVA, followed by the Tukey honest significant difference multiple comparisons test (α=.05). ResultsMean ±SD failure loads ranged from 687.5 ±84.0 N to 943.8 ±93.1 N. One-way ANOVA revealed a statistically significant difference among the groups (P≤.05). The control group (GHT) had significantly higher resistance to fracture than the other groups (P≤.05). ConclusionsWithin the limitations of this in vitro study, placement of a fiber post did not affect the fracture resistance of endodontically treated maxillary central incisors with 2 Class III restorations.

Survey of dentists to determine contemporary use of endodontic posts

Statement of problemAlthough the scientific literature provides sound decision-making tools for the restoration of endodontically treated teeth, dentists have different opinions on the rationale for the use of endodontic posts (dowels) and selection of post systems. The decision to place a post is at times contrary to the literature. Updated information on the treatment of endodontically treated teeth among general dentists is lacking. PurposeThe purpose of this survey was to gain insight into the rationale for choice of endodontic posts and the different endodontic post systems currently used by dental practitioners. Post and core restorations distribute stress and replace missing tooth structure in endodontically treated teeth. Guidelines exist to help select post systems. With the advent of new materials, prefabricated posts have gained popularity among dentists. However, cast-metal post-and-core systems are still considered the gold standard. Material and methodsSurveys were distributed to dentists attending continuing education meetings in the United States, Canada, Scotland, Ireland, and Greece. The questions addressed years of practice, specialty training, and brand, type, shape, and material of the endodontic post systems used. ResultsDescriptive statistical analysis was used to assess the percentage of respondents. Ninety-two percent of the participants were general practitioners with 25.94 ±13.35 years of experience. The majority agreed upon using endodontic posts when insufficient coronal tooth structure remains and for stress distribution. Passive, parallel posts were the most commonly reported type and shape. With regard to post material, fiber posts were the most frequently used (72.2%), followed by prefabricated alloys (38.6%), cast-metal posts (33.9%), prefabricated titanium posts (30.1%), and stainless-steel posts (21.7%). For cementation, resin-modified glass ionomer (40%) was most frequently used, followed by self-adhesive resin (29.6%). ConclusionsThe majority of the practitioners used fiber posts. This may be because, in terms of fracture, they compare favorably with cast-metal post and core, although little evidence in the literature validates this claim.

Effect of fiber posts on the fracture resistance of endodontically treated anterior teeth with cervical cavities: An in vitro study

Statement of problemHow the placement of fiber posts affects the fracture resistance of endodontically treated maxillary central incisors with cervical cavities is not well documented. PurposeThe purpose of this in vitro study was to evaluate the effect of fiber posts on the fracture resistance of endodontically treated maxillary central incisors with cervical cavities. Material and methodsFifty extracted human maxillary central incisors were selected and divided into 5 test groups (n=10) according to the restoration strategy: GHT, control group; endodontically treated teeth (ETT) without endodontic posts; GCV, ETT with cervical cavities simulating coronal destruction; GCF, ETT with cervical cavities and carbon fiber posts; GGF, ETT with cervical cavities and glass fiber posts; and GCP, ETT with cervical cavities and composite resin posts. After the fiber posts had been cemented with a resin cement and the foundations had been placed, all specimens were quasi statically loaded at 45 degrees in a universal testing machine until fracture. All specimens were evaluated for fracture modes. The data were then analyzed by 1-way ANOVA, followed by multiple comparisons with the Tukey HSD test (α=.05). The mode of failure was determined by visual inspection. ResultsThe mean ±SD failure loads for the groups ranged from 718.2 ±89.8 N to 943.8 ±93.1 N. In a 1-way ANOVA followed by post hoc testing, GGFs had a higher fracture strength than all other groups (P≤.05). However, GCPs had a lower fracture strength than all other groups. Statistically significant differences were observed among groups (P≤.05), except between the GHT group and the GCF and GGF groups (P=.075, P=.226). All groups except GHT showed complete favorable fracture mode within the cervical third of the roots. ConclusionsWithin the limitations of this in vitro study, placement of glass fiber posts significantly improved the fracture resistance of endodontically treated maxillary central incisors with cervical cavities.

Development of new radiopaque glass fiber posts

The aim of this study was to analyze the radiopacity and filler content of three experimental glass fiber posts (EGFP) in comparison with other glass/carbon fibers and metal posts from the dental market.Three EGFP were obtained by pultrusion of glass fibers in a polymer matrix based on 2,2-bis[4-(2-hydroxy-3-methacryloyloxypropoxy)-phenyl]propane (bis-GMA) and triethyleneglycol dimethacrylate (TEGDMA) monomers. Using intraoral sensor disks 27 posts, as well as mesiodistal sections of human molar and aluminum step wedges were radiographed for evaluation of radiopacity. The percentage compositions of fillers by weight and volume were investigated by combustion analysis.Two EGFP showed radiopacity higher than enamel. The commercial endodontic posts showed radiopacity as follows: higher than enamel, between enamel and dentin, and lower than dentin. The results showed statistically significant differences (p<0.05) when evaluated with one-way ANOVA statistical analysis. According to combustion analyses, the filler content of the tested posts ranges between 58.84wt.% and 86.02wt.%. The filler content of the tested EGFP ranged between 68.91wt.% and 79.04wt.%.EGFP could be an alternative to commercial glass fiber posts. Future glass fiber posts are recommended to present higher radiopacity than dentin and perhaps ideally similar to or higher than that of enamel, for improved clinical detection. The posts with a lower radiopacity than dentin should be considered insufficiently radiopaque. The radiopacity of some glass fiber posts is not greatly influenced by the amount of filler.

유리섬유 강화 근관치료 포스트의 제조 및 특성에 대한 연구

*Korea Institute of Ceramic Engineering and Technology, Jinju 660-031, Korea**Division of Materials Science and Engineering, Hanyang University, Seoul 133-791, Korea(Received April 13, 2015)(Revised April 16, 2015)(Accepted April 24, 2015)Abstract The fiber-reinforced endodontic posts were prepared using a photocurable resin and a glass fiber. Themechanical property of the posts increased with increasing density of glass fiber and the micro-pores in the post wereremoved by a vacuum impregnation process. To improve the interfacial adhesion between glass fiber and polymer, silanecoupling agent was used. The surface treatment of glass fiber increased the surface wettability of resing on glass fiber andincreased the adhesion property with resin, consequently improved the mechanical property of posts.Key wordsFiber reinforced endodontic post, Glass fiber, Photocurable resin, Interfacil adhesion, Mechanical property

Stress generated by customized glass fiber posts and other types by photoelastic analysis.

Endodontic posts are necessary to provide adequate retention and support when no sufficient remaining structure is available to retain the core. There are different materials and techniques to construct post-and-core, but there is no consensus about which one promotes better stress distribution on the remaining tooth structure. This study aimed to quantify and evaluate the distribution of stress in the root produced by customized glass fiber posts compared to different endodontic posts. Twenty-five simulated roots from photoelastic resin were made and divided into 5 groups: CPC, cast post-and-core; SP, screw post; CF, carbon fiber post; GF, glass fiber post; and CGF, customized glass fiber post. After cementing CPC and SP posts with zinc phosphate cement, and CF, GF and CGF posts with resin cement, resin cores were made for groups 2-5. Specimens were evaluated with vertical or 45° oblique loading. To analyze the fringes, the root was divided into 6 parts: palatal cervical, palatal middle, palatal apical, vestibular cervical, vestibular middle, and vestibular apical. The formed fringes were photographed and quantified. Data were recorded and subjected to two-way ANOVA and Tukey's test (5%). SP (1.95±0.60) showed higher stress (p<0.05) compared to the others (CPC-0.52±0.74; CF-0.50±0.75, GF-0.23±0.48 and CGF-0.45±0.83). All posts showed high stress in apical third (CPC-1.40±0.65; SP-2.30±0.44, CF-1.80±0.45, GF-1.20±0.45, CGF-1.70±1.03) Low stress was found in cervical third (CPC-0.20±0.45; CF-0.00±0.00, GF-0.00±0.00, CGF-0.00±0.00), except by SP (1.90±0.65), which showed statistical difference (p<0.05). Customized post showed high stress concentration at the root and conventional glass fiber posts showed more favorable biomechanical behavior.

Fracture load and force load at upper yield of alkaline‐resistant glass fiber‐reinforced endodontic posts

Three experimental glass fiber posts (EGFP) based on 2,2‐bis[4‐(2‐hydroxy‐3‐methacryloyloxypropoxy)‐phenyl] propane, triethyleneglycol dimethacrylate monomers, and alkaline‐resistant (AR) glass fibers were obtained. The EGFP as well as 29 commercial endodontic posts were investigated for fracture load, force load at upper yield, and filler content. Each post was loaded at a 135° angle to the root's long axis using a universal testing machine, and the maximum strength was recorded. EGFP showed the fracture load values from 68.02 to 115.97 N, and the force load at upper yield values from 38.70 to 70.46 N. The filler content of the EGFP ranged between 49.64 and 62.67 vol%. EGFP showed mechanical strength comparable to other posts already on the market. A polymer matrix based on bis‐GMA/TEGDMA and AR glass fibers could be an alternative to epoxy resin and glass fibers from commercial endodontic posts. POLYM. COMPOS., 38:260–267, 2017. © 2015 Society of Plastics Engineers

Analysis of the effect of design parameters and their interactions on the strength of dental restorations with endodontic posts, using finite element models and statistical analysis

Many previous studies, both in vitro and with model simulations, have been conducted in an attempt to reach a full understanding of how the different design parameters of an endodontically restored tooth affect its mechanical strength. However, differences in the experimental set-up or modelling conditions and the limited number of parameters studied in each case prevent us from obtaining clear conclusions about the real significance of each parameter. In this work, a new approach is proposed for this purpose based on the combination of a validated three-dimensional parametric biomechanical model of the restored tooth and statistical analysis using full factorial analysis of variance. A two-step approach with two virtual tests (with, respectively, 128 and 81 finite element models) was used in the present work to study the effect of several design parameters on the strength of a restored incisor, using full factorial designs. Within the limitations of this study, and for cases where the parameters are within the ranges that were tested, the conclusions indicate that the material of the post is the most significant factor as far as its strength is concerned, the use of a low Young's modulus being preferable for this component. Once the post material has been chosen, the geometry of the post is of less importance than the Young's modulus selected for the core or, especially, for the crown.

Effect of ferrule location on the fracture resistance of crowned mandibular premolars: An in vitro study

Statement of problemHow the location of a ferrule affects the fracture resistance of endodontically treated mandibular premolars is unclear. PurposeThe purpose of this in vitro study was to compare the effect of ferrule location on the fracture resistance of endodontically treated mandibular premolars. Material and methodsSeventy-two extracted human mandibular premolars were selected and divided into 6 test groups (n=12) according to ferrule location: control group, GHT; endodontically treated teeth without endodontic posts and crowns, GCF; teeth with a 2 mm circumferential ferrule, GBF; teeth with a 2 mm buccal ferrule; GLF, teeth with a 2 mm lingual ferrule; GBLF, teeth with a 2 mm buccal and lingual ferrule; and teeth without ferrule, GWF. After glass fiber posts were cemented with a self-adhesive resin cement and foundation restorations were placed, NiCr crowns were luted to each prepared tooth. All specimens were quasistatically loaded at 30 degrees in a universal testing machine until fractured. Data were then analyzed with 1-way ANOVA, followed by multiple comparisons using the Tukey honestly significant difference test (α=.05). ResultsMean ±SD failure loads for groups ranged from 791.1 ±177.5 N to 1086.1 ±181.1 N. One-way ANOVA revealed a statistically significant difference between the groups (P≤.05). However, no statistically significant differences were observed among groups (P>.05), except between GHT (control group) and groups GBLF and GWF (P=.025, P=.022). ConclusionsWithin the limitations of this study, the location of the ferrule had no significant effect on the fracture resistance of endodontically treated mandibular premolars.

ENDODONTİK TEDAVİLİ DİŞLERİN RESTORASYONUNDA POST MATERYALLERİ

Knowledge of posts is associated with the success or failures of the restoration because of endodontic posts are part of the restorative system. Endodontic posts are manufactured in different ways and different materials from past to present. These variable post systems have advantages and disadvantages to each other. This article provides information about endodontic post systems for safety of restoration of endodontically treated teeth