Fibre-reinforced Posts Research Articles

Survival of Endodontically Treated Maxillary Anterior Teeth with Aesthetic Post-Restoration: A Prospective Intervention Study

Introduction: There is much debate over the best choice of restorative material and the placement method for the most successful treatment. Many teeth that have undergone endodontic treatment may not have enough structure to support a restoration or crown. To improve retention for the restorative material, ferrule may be used. Adhesive techniques have transformed the way we restore teeth after root canal treatment, starting with the shift from using cast post-and-core to using fibre post. The use of fibre-reinforced posts has been found to prevent irreparable root fractures thereby improving the longevity of the treatment. Aim: To compare two different types of aesthetic fibre posts for 12 months. Materials and Methods: A prospective interventional study was carried out in the Department of Prosthodontics, Manav Rachna Dental College (Faridabad) for a period of 12 months from Nov 2022- Oct 2023. Forty participants with single rooted, endodontically treated, maxillary anterior teeth in the age bracket of 15-55 years, both males and females of the north Indian population were included in the study. Teeth were selected where a post-retained crown was indicated and post space was prepared using a piezo reamer drill at 5000 rpm. At least 4 mm of obturation is left in the canal to maintain the apical seal. Furthermore, Zircon-enriched silicon fibre and glass fibrereinforced posts were cemented into the prepared post space. Metal-ceramic crowns were cemented and baseline periapical radiographs were obtained. At the interval of one month, three months, six months and one year, the patients were evaluated. The Fischer’s exact test was utilised to establish the association between categorical variables and the level of significance (p-value <0.05). Results: One year follow-up revealed no failures in crown movement when evaluated under finger pressure, recurrent caries, or root fractures. One case of glass fibre-reinforced post showed a fracture of the post and another case of glass fibre post showed periapical radiolucency at 6-month intervals on clinical and radiographical examination which was significant when compared to Zircon-enriched silicon fibre post group (p-value=0.02). Conclusion: Both aesthetic fibre-reinforced post systems used in single-rooted upper anterior teeth demonstrated similar success rates in restoring root canal treated teeth.

Fibre-reinforced Cad/CAM post and cores: The new “gold standard” for anterior teeth with extensive coronal destruction?–A fully digital chairside workflow

ObjectivesSince one-third of persons suffer a dental trauma, treatment of anterior teeth using post and core (PC) is becoming important. In teeth with extensive destruction, cast PC (CPC) remain the “gold standard”, even though they lead to aesthetic impairment and have a mismatching elastic modulus to that of dentin. Prefabricated fibre-reinforced posts have elastic modulus similar to that of dentin but the accuracy of fit and mechanical stability are worse. This study was aimed to evaluate the deviation and mechanical performance of fibre-reinforced CAD/CAM PC (FRPC) fabricated in a fully digital chairside workflow, compared to those of CPC. MethodsOn 30 teeth, a PC preparation was conducted, and a conventional and digital post impression were taken with an intraoral scanner. Fifteen teeth each were treated with CPC and FRPC, respectively. The deviation was evaluated by superimposing the datasets of the digitalised stone models and digital post impressions. Decementation and root fracture during chewing simulation were analysed by microscopy and X-ray. Statistical analysis was performed by pairwise comparison and Kaplan-Meier analysis. ResultsThe median deviation for the “coronal”, “middle” and “apical” were 14.5, 18.0 and 113.7 μm, respectively. The pairwise comparison for “coronal”/“middle” showed no significance (p = 0.465), whereas that for “coronal”/“apical” and “middle”/“apical” showed highly significant differences (p < 0.001). After chewing simulation, five decementations and two root fractures were detected for CPC. For FRPC, neither decementation nor root fracture were documented. SignificanceWithin the limitations of this study, FRPC performed significantly better than CPC.

Antimicrobial and ultrastructural properties of root canal filling materials exposed to bacterial challenge

IntroductionChemo-mechanical preparation of the root canal leaves behind viable bacteria which can lead to treatment failure. Materials used inside the root canal should possess antimicrobial properties and also resist disintegration in the presence of biofilm. MethodsGutta-percha, three root canal sealers (Pulp Canal Sealer, AH Plus and BioRoot RCS) and materials used to make posts (a metal and a resin) were evaluated. Their antimicrobial activity against Enterococcus faecalis in direct contact was assessed by scanning electron microscopy and live-dead staining using confocal microscopy over a period of eight weeks. The materials’ structural integrity was assessed by scanning electron microscopy. ResultsThe antimicrobial activity of the materials varied. The metal alloy posts as well as BioRoot RCS sealer did not allow any biofilm accumulation; but gutta-percha, Pulp Canal Sealer and resin from fibre-reinforced posts encouraged thick biofilm accumulation. Microstructural changes were observed in AH Plus (washout) and BioRoot (crystal deposition) in contact with biofilm. The Pulp Canal and BioRoot RCS sealers exhibited a modified ion leaching pattern in contact with microbially loaded media. ConclusionsThe microbial challenge affected the material microstructure in some of the materials tested and allowed biofilm accumulation. Although clinical success depends on a number of factors, materials that are structurally sound and exhibit antimicrobial properties are preferable for endodontic therapy and tooth restoration involving entry in the root canal.

Efficacy of Fiber Post Bonding To Root Dentin after Different Obturation Techniques and Cementation Timings: In Vitro Study.

OBJECTIVE:The aim of this in vitro study was to assess the effect of obturation technique and cementation timings on the bonding of fibre-reinforced posts to the root canal walls.METHODS:Twenty extracted teeth were randomly allocated to two groups according to the obturation technique and cementation timing. Central incisors with single canals were used after being decoronated. Every extracted tooth of the {vertical compaction group} (VC) group (n = 10) had been obturated using the {E & Q plus obturation system} with posts cemented in the same day; The other (CO) conventional group (n = 10) teeth were obturated using the conventional lateral compaction technique and posts cemented after one week. “SF” Fiber posts were used after bonding and cementation using Rely X ARC resin cement with all the endodontically treated teeth. The push-out test was performed in a universal testing machine. Data were analysed by 2 way analysis of variance with Statistical significance was set to 0.05.RESULTS:Heat softened gutta percha group showed more push out the bond strength of the bonded posts than the conventional obturation group (p < 0.05). In the middle region, there was no statistical significance between the two groups while there was significance in the coronal and apical thirds.CONCLUSION:The vertical compaction technique and early cementation improved the bond strength of the resin posts in comparison to the conventional obturation technique with late cementation.

Bond strength of glass fibre-reinforced posts with composite cement

Introduction. The most common failure in using glass fibre-reinforced composite posts is cementation of the post, i.e. the lack of junction between cement dentine or post. Aim of the study. To compare the bond strength between different glass fibre-reinforced composite (FRC) posts and selected composite cement. Materials and Methods. The following seven types of fiber reinforced composite posts (n =10): Fiber Post (GC Europe N.V., Leuven, Belgium), Glassix (Harald Nordin SA, Chailly s/ Montreux, Switzerland), Rebilda®Post (VOCO GmbH, Cuxhaven, Germany), FibreKleer Serrated Post (Pentron Clinical, Wallingford, USA), ParaPost®Fiber Lux (Coltene/Whaledent Inc., Cuyahoga Falls, USA), RelyX (3M Espe Dental Products, St.Paul, USA) oraz X-Post (Dentsply Maillefer Instruments, Ballaigues, Switzerland) were evaluated. Posts were cemented into metal sleeves with dual-cure resin cement CoreXFlow (Dentsply). The bond strength test based on the coaxial method was performed on the samples using Instron 4485 machine (Instron Corporation, Norwood, USA). Results. The significantly higher values of bond strength were demonstrated for Fiber Post (GC Europe N.V., Leuven, Belgium) with 29.57±1.44 MPa, and the lowest were shown by Glassix (Harald Nordin SA, Chailly s/Montreux, Switzerland) with 17.21±0.87 MPa. The differences were significant (p&lt;0.001). Conclusions. 1. The significantly higher values of bond strength were demonstrated for Fiber Post (GC Europe N.V., Leuven, Belgium) and the lowest were shown by Glassix (Harald Nordin SA, Chailly s/Montreux, Switzerland). 2. The resin methacrylic posts had a stronger junction with cement than with epoxy resin posts.

Metal or fibre posts and root fractures.

Abstract Data sourcesMedline and the OpenThesis database.Study selectionRandomised clinical trials (RCTs) and cohort studies comparing the incidence of root fractures of metallic and fibre-reinforced composite posts with more than five years follow up were considered.Data extraction and synthesisTwo reviewers independently selected studies and assessed study quality. The Cochrane risk of bias tool was used to assess RCTs and the Newcastle-Ottawa Scale for cohort studies. Root fracture leading to tooth extraction was considered a catastrophic failure and defined as the primary outcome. Secondary outcomes (non-catastrophic failures) included endodontic failures, crown dislodgement, post debonding, and post/core fractures. The incidence rate of root fractures and non-catastrophic failures was calculated by dividing the number of events by the period of risk for all included posts during the study period per 1000 post years of follow-up.ResultsFourteen studies (seven RCTs and seven cohorts) were included involving 3202 patients and 4752 posts. In all there were 62 root fractures and 467 non-catastrophic failures.The incidence rate of root fractures (pooled event rate per 1000 post years) for metal posts (four RCTs, four cohorts) was 5.13 (95% CI, 4.05-6.21) compared with 4.78 (95% CI, 4.28-5.27) for the fibre-reinforced posts (five RCTs, three cohorts). The pooled survival rate for was metal posts = 90% (95% CI 85.5- 93.3) compared with 83.9% (95% 67.6-92.8) for fibre-reinforced posts. Heterogeneity between the studies was high. The incidence rate of non-catastrophic failures for metal-based posts (four RCTs, 3 cohorts) was 12.69 (95% CI, 7.90-17.48) per 1000 post years compared with 19.39 (95% CI, 13.21-25.57) for fibre-reinforced posts. Heterogeneity was again important.ConclusionsThe results of the present systematic review based on clinical studies do not support the indication of fibre-reinforced posts based on a reduction of catastrophic failures. However, this review also showed the need for further well designed clinical studies evaluating intra-radicular posts.

Restoration of endodontically treated anterior teeth with cast metallic post or prefabricated fibre post placement: 2 case reports and critical literature review

With a wide variety of post systems and materials available for the restoration of lost tooth structure of endodontically treated teeth, the clinical decision of which to use constitutes a challenge to dental practitioners. Cast metal post and cores are widely used for restoring endodontically treated teeth with extensive loss of coronal tooth structure and to retain metal-ceramic crowns. When dental aesthetics is of primary concern, the selection of the underlying restorative material becomes an important factor to consider. The fibre-reinforced posts combined with all-ceramic crowns offer a highly aesthetic outcome in anterior region restorations, but long-term evaluation is necessary in order to assess their clinical performance and longevity. The purpose of this paper was to present and compare 2 restorative options with regard to materials (cast metallic post and core versus prefabricated fibre post and composite resin core) for the prosthetic rehabilitation of cases with inadequate aesthetic appearance or fractured maxillary anterior teeth. Furthermore, the article reviews the main indications, advantages, and disadvantages from the use of the 2 post types combined with the final restorations, in order to allow the dental practitioner make the selection of appropriate restorative materials.

Reattachment of Anterior Tooth Fragment Using Fibre Post: A Clinical Case Report

Dental trauma is a situation where in the patient is affected both socially and psychologically. Coronal fractures of permanent dentition are the most frequent type of dental injury. The prime objective while handling such cases is successful pain management with immediate restoration of function, esthetics and phonetics. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols. The development and use of fibre-reinforced posts makes the reattachment of the crown possible, esthetically. This case report presents a clinical technique of reattachment of coronal fragment of maxillary lateral incisor after trauma using direct fiber-reinforced post systems.

Funderingsrestauraties bij uitgebreid weefselverlies van gebitselementen

After (extensive) loss of tooth tissue, vital teeth can be built up completely with composite restoration material. Sometimes, the application of additional retentive preparations is indicated. In exceptional cases, a root canal treatment is indicated, following which a root canal post is applied if necessary. Endodontically treated multi-rooted teeth can be built up entirely with composite, utilizing the pulp chamber and root canal accesses for retention. However, in single-rooted teeth a root canal post is necessary, in which case a prefabricated root post is used. Traditionally, metal posts were used in combination with a cast, indirect build-up restoration. Subsequently, directly fabricated cores, combining metal posts with amalgam or, at the present time, composite restoration material, became customary. The present trend is to use prefabricated or individually fabricated fibre-reinforced posts. After restoring a tooth with a build-up restoration, a combined build-up restoration can be chosen, or a direct or indirect crown single tooth prosthesis.

Flexural strength of glass fibre-reinforced posts bonded to dual-cure composite resin cements

Flexural strength of glass fibre-reinforced posts bonded to dual-cure composite resin cements

Fracture resistance of incisor teeth restored using fibre‐reinforced posts and threaded metal posts: effect of post length, location, pretreatment and cementation of the final restoration

The hypothesis of this study was that the fracture load of incisor teeth restored using short, threaded, parallel-sided posts (TMP) is, under special conditions, not inferior to that of teeth restored using long TMPs or fibre-reinforced posts (FRP). Seventy-two maxillary incisors and 72 mandibular incisors were collected. Sixty-four in each group were root filled; in half of these FRPs were cemented, and in the other half TMPs were used. Half of the FRPs were pretreated; the others were not pretreated. In the TMP-group, half of the teeth received a long post (10 mm), the other half a short post (3 mm). Crowns were fabricated and cemented with Ketac-cem or Panavia. Eight maxillary incisors and eight mandibular incisors with intact natural crowns were used as control groups. All specimens were loaded until fracture. Fracture loads were higher for pretreated FRPs than for untreated FRPs. If the FRPs were not pretreated, fracture loads for maxillary incisors after use of short metal posts were significantly higher (248 N compared with 133 N, P = 0.027). Fracture loads for teeth restored using long TMPs were not higher than for teeth restored using short TMPs (277 N compared with 266 N). Fracture loads for mandibular incisors restored using long (10 mm) pretreated FRP were higher than for mandibular incisors restored using short (3 mm) metal posts (436 N compared with 285 N). Cementation of the crowns using an adhesive resin cement did not increase the fracture load for mandibular incisors, whereas for maxillary incisors, this cementation technique tended to increase fracture loads in teeth restored with FRP, although this increase was not significant at the P < 0.05 level (P = 0.06). In both groups, fracture loads were higher for mandibular incisors. Short, threaded, parallel-sided metal posts might be an alternative to fibre- reinforced posts for maxillary incisors, for teeth with short roots or when FRP cannot be pretreated.

Flexural strength of glass fibre‐reinforced posts bonded to dual‐cure composite resin cements

The aims of this study were to evaluate the flexural strength of two different types of glass fibre-reinforced posts bonded to dual-cure composite resin cements. Forty glass methacrylate-based fibre posts (GC Fiber Post) and 20 glass fibre inter-polymerizing network posts (everStick POST) were divided into three groups. Group 1 contained 20 GC posts that were bonded to a dual-cure composite cement (UnifilCore). Group 2 contained 20 Stick Tech posts that had adhesive applied (Scotchbond Multipurpose resin) and were bonded to a dual-cure composite resin cement (RelyX Unicem). Group 3 contained 20 GC posts that were pretreated with a silane-coupling agent before being treated with resin and composite, as in group 1. A 4-point bend test was carried out to failure on all of the groups. Failure modes were determined using scanning electron microscopy. Pretreatment of the post surface with the silane-coupling agent did not increase the flexural strength. The flexural strength of the Stick Tech post was significantly lower than the flexural strength of the GC post. The mode of failure for the GC Posts was adhesive, whereas the Stick Tech posts failed cohesively. Different flexural strengths and failure modes were observed among the two fibre post-resin systems.

Effect of luting cement to push-out bond strength of fibre reinforced post

he objective of this study was to investigate the effect of various luting cement systems on bond strength of fibre-reinforced posts to root canal dentine. 40 extracted single rooted sound premolar teeth were root filled, decoronated and randomly divided into four groups. Fibre posts, Aestheti- Plus™ (Bisco,Inc. Schaumburg, IL, USA) were cemented using four luting cements: Group A (control): Elite 100® Zinc phosphate (GC Corp, Japan), Group B: Calibra ™ Esthetic Resin Cement (Dentsply Caulk, USA), Group C: RelyX ARC Adhesive Resin (3M ESPE), Group D: RelyX Unicem Aplicap (3M ESPE). Each root was sliced into 2 discs representing the coronal and middle portions of the root canal giving rise to 20 specimens per group. Bond strength was determined using push-out tests and data was analyzed using SPSS version 14.0. The mean bond strength of Group A to Aestheti-Plus™ post was 7.71 MPa (±2.51) and Group B was 5.69 MPa (±3.23). Group C exhibited the lowest mean bond strength, 4.29 MPa (±3.53) while the highest bond strength was obtained from Group D, 7.98 MPa (±2.61). One way ANOVA showed significant interaction between all groups (p=.OOI). Post-hoc Bonferroni test reve;iled that bond strength of Group C was significantly lower compared to Group A (p=.008) and D (p=.004). In conclusion, the mean bond strength of Aestheti- Plus™ post to root canal dentine was highest when cemented with RelyX Unicem resin cement followed by Elite 100® zinc phosphate cement, Calibra and RelyX ARC resin cements. However, the bond strengths of Cali bra and RelyX Unicem resin cements were not significantly different from Elite 100® zinc phosphate cement.

Influence of core material on fracture resistance and marginal adaptation of restored root filled teeth

To investigate ex vivo the influence of direct placement core materials on the fracture strength and marginal adaptation of root filled maxillary central incisors restored with glass fibre-reinforced posts, various core materials and all-ceramic crowns. Forty-eight human maxillary incisors were root filled. Posts were placed and teeth restored with composite cores and crowns (n = 8). Six core materials were examined after thermal cyclic and mechanical loading (TCML). Fracture force was determined under static loading. The marginal adaptation at the interfaces between cement-tooth and cement-crown were categorized as 'intact margin' or 'marginal gap' using scanning electron microscopy. Statistical analysis was undertaken with the Mann-Whitney U-test (alpha = P < or = 0.05). Median fracture strength varied between 204 N (low viscous experimental core) and 1094 N (Multicore). No difference in fracture resistance was found with varying viscosity of the core material. The layering technique improved the fracture performance (P = 0.059) to a minor degree. Crowns with dedicated core materials (Rebilda 1063 N; Multicore 1094 N) had a significantly higher fracture resistance than crowns with a conventional restorative material (Tetric Ceram 509 N). Significantly poorer marginal adaptation before TCML was found for the layering technique at the tooth-cement interface and for all experimental cores after TCML. At the crown-cement interface significant differences in marginal adaptation could be determined between Multicore-layered core (P = 0.002) and Multicore-Rebilda (P = 0.001) after TCML. The fracture strength of post and core restorations was dependent on the core material and bonding system. Marginal adaptation was influenced by the method of application of the core material and by TCML.

The effect of alveolar bone loss on the load capability of restored endodontically treated teeth: A comparative in vitro study

The aim of the present investigation was to study the influence of a reduced bone support on the fracture resistance of endodontically treated teeth restored with glass fibre-reinforced posts (FRC). 30 caries-free maxillary central incisors were divided into 3 groups (n=10). Endodontic treatment was performed. Teeth were flattened 2 mm above the cemento-enamel junction. Group I (control) simulated a clinical situation without horizontal bone loss. In group II a horizontal bone loss of 25% and in group III of 50% was simulated. All specimens received FRC posts and composite core restorations. All-ceramic crowns were adhesively cemented. Specimens were exposed to thermal cycling and mechanical loading (TCML) and finally statically loaded until failure in a universal testing machine (v=1 mm/min). Non-parametric tests were used to compare median fracture loads between groups. Fracture modes were compared using Fisher's exact test. The median fracture load values (min/max) in [N] were: group I=501 (326/561), group II=422 (323/495); group III=352 (266/406), p=0.004. Two specimens in each group II and III failed during TCML. Statistical analysis revealed statistically significant differences between all test groups regarding maximum fracture load and mode of fracture. The fracture resistance of endodontically treated teeth restored adhesively with a FRC post, composite core, and all-ceramic crown is dependent on the level of surrounding supporting periodontal bone. Loss of alveolar bone loss due to periodontal disease may lead to an increased risk of failure.

Yield strength of zirconia and glass fibre‐reinforced posts

The aim of this in vitro study was to evaluate the yield strengths of glass fibre-reinforced composite (FRC) posts and zirconia dioxide ceramic (ZDC) posts. Tapered glass FRC posts (DentinPost) and ZDC posts (Cerapost) of three sizes in diameter (ISO 50, 90, 110) were used for bending tests. Conventional prefabricated titanium posts of the same sizes served as control groups. The 0.2% yield strengths (R(0.2)) were tested on a universal testing machine. As zirconia posts fractured before they were yielded 0.2%, the fracture strength instead of the yield strength was recorded for these posts. One-way and two-way anova and Bonferroni-Dunn's multiple comparison tests were performed for the statistical analysis. The mean 0.2% yield strengths of the posts were 27 +/- 1 N for glass fibre-reinforced posts and 58 +/- 4 N for zirconia posts of ISO 50 (control group: 54 +/- 3 N). For ISO 90 yield strengths of 52 +/- 4 N for glass fibre-reinforced posts, 117 +/- 20 N for zirconia posts and 117 +/- 11 N for the control group were obtained. For ISO 110 mean yield strengths amounted to 73 +/- 5 N for glass fibre-reinforced posts, 166 +/- 23 N for zirconia posts and 141 +/- 12 N for the control group. Significantly higher yield strength was recorded for the zirconia and the titanium posts compared with the glass fibre-reinforced posts for the tested ISO sizes.

Effect of luting agents and reconstruction techniques on the fracture resistance of pre‐fabricated post systems

Fracture resistance and fracture modes of endodontically treated maxillary central incisors restored with different post-and-core systems covered with all-ceramic copings were evaluated. Ten samples were prepared for each group. Groups 1, 2 and 3 consisted of tooth-coloured post-and-core, zirconia post (Cosmopost) with a composite core (Tetric Ceram), zirconia post (Cosmopost) with a custom made ceramic core (Cosmo Ingot), glass fibre-reinforced post (FRC Postec) with a composite core (Tetric Ceram), respectively. Group 4 consisted of a titanium post (ERpost) with a composite core (Tetric Ceram). The control group (group 5) consisted of root-filled incisors without posts. Tooth-coloured posts were cemented in the roots using Variolink-2, while titanium posts were cemented in the roots using Harvard cement. The all-ceramic copings were cemented using Variolink-2. Static load was applied to 2 mm below the incisal edge on the palatinal surface of each sample until they were fractured. Fracture data were obtained and statistically analysed with One-way anova and a Tukey's test. The results of the means and standard deviations of the fracture resistance during static loading were: 497.5 +/- 61.94 (1), 474.61 +/- 96.84 (2), 494.61 +/- 104.67 (3), 581.34 +/- 105.36 (4), 420.42 +/- 127.48 (5). There were statistically significant differences between groups 4 and 5. Glass fibre-reinforced posts and composite cores (group 3) showed the most catastrophic failure. Consequently, zirconia ceramic posts can be used in clinical practice.