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Objectives: This review was undertaken to answer a controversial clinical question with high-quality evidence: When severely damaged teeth are restored, which type of post (metal or fiber) demonstrates superior clinical performance?, Data Sources: The meta-analysis was conducted according to the guidelines in the Cochrane handbook. Electronic databases (MEDLINE, EMBASE, CENTRAL) and gray literatures were screened up to January 2018. Only randomized controlled trials (RCTs) with follow-up of at least 3 years were included. The quality of included studies was assessed by the Cochrane Collaboration's tool. Meta-analysis compared survival, success, post debonding, and root fracture incidence of teeth restored with fiber and metal posts. The GRADE system (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the strength of the evidence. Of 1,511 records, 14 full texts were obtained. Only four RCTs with follow-up times of 3 to 7 years met the selection criteria. The methodologic quality of included RCTs was low risk of bias. Fiber posts presented significantly higher survival rates than did metal posts (RR 0.57, 95% CI: 0.33 to 0.97, P = .04), while no difference was observed in success rates, post debonding rates, or root fracture rates. The GRADE assessment indicated a high quality of evidence for survival rates and a moderate quality for success rates., Conclusion: It was concluded that fiber posts displayed higher medium-term (3 to 7 years) overall survival rates than did metal posts when used in the restoration of endodontically treated teeth with no more than two coronal walls remaining.

The loss of an entire tooth in the anterior region is accompanied by impairment of esthetics, function, phonetics, and self-esteem. It is common knowledge that treatment with implants during childhood or early adolescence is not an option. Splinting of adjacent teeth during growth and development may interfere with the independent process of teeth realignment and repositioning during that phase of life. Other creative solutions must be offered, such as free-standing composite buildup restorations on compromised broken teeth or single wing/cantilevered restorations adhered to one neighboring tooth during the growth period. The positive effects of reinforced composite materials were researched and presented in the literature. Their use is clearly indicated for interim and economical restorations. Long-term follow-up on a mandibular incisor that experienced trauma, losing its clinical crown and vitality when the patient was 12 years of age, is discussed with all the various aspects of material selection, future considerations, and long-term follow-up to adulthood, when a conventional crown was prepared and delivered.

Objective: To assess the survival rate of two different post systems after 5 years of service with a prospective randomized controlled trial., Method and Materials: One hundred patients in need of a post were studied. Half of the patients received long glass fiber-reinforced posts, while the other half received long metal screw posts. The posts were assigned randomly. After at least 5 years (mean, 61.37 months), follow-ups were established. When a complication occurred prior to this recall, the type and time of the complication was documented. Statistical analysis was performed using the log-rank test and Kaplan-Meier analysis. Additionally, a Cox regression was performed to analyze risk factors., Results: The survival rate of fiber-reinforced posts was 71.8%. In the metal screw post group, the survival rate was significantly lower, 50.0% (log-rank test, P = .026). Metal posts resulted more often in more unfavorable complications (eg, root fractures); consequently, more teeth (n = 17) had to be extracted. The Cox regression identified the following risk factors: position of the tooth (anterior vs posterior teeth), degree of coronal tooth destruction, and the post system (fiber-reinforced post vs metal screw post). Fiber-reinforced restorations loosened in several patients; in some of these cases (n = 6), patients did not notice this, leading to the extraction of teeth., Conclusion: Long metal screw posts should be used with great care in endodontically treated teeth. Besides the selection of the post system, other factors influence the survival of the restoration.

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central incisor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite resin veneer on the traumatized tooth.

Objectives: To investigate the push-out bond strengths of one epoxy resin-based quartz-fiber post with four adhesive systems., Method and Materials: Forty-four single-rooted, single-canal teeth were randomly divided into four groups (n = 11): One-step (One-Step + Duo-link; Bisco), Variolink II (Excite DSC + Variolink II; Ivoclar Vivadent), Panavia F (ED primer + Panavia F; Kuraray), and RelyX (RelyX Unicem; 3M ESPE). All teeth crowns were removed, and the roots were treated with root canal therapy. Four adhesive systems were employed for bonding of one type of quartz-fiber post, strictly according to the manufacturers' instructions. Ten roots in each group were transversely sectioned into cervical, middle, and apical third slices 2 mm thick, and the bond strengths were measured with the push-out test. The other root was processed for SEM analysis. Two-way ANOVA, one-way ANOVA, and Student-Newman-Keuls test were used for statistical analysis., Results: The push-out bond strengths were 7.15 +/- 3.43 MPa (RelyX), 12.48 +/- 9.33 MPa (One-step), 2.96 +/- 2.76 MPa (Panavia F), and 13.43 +/- 6.14 MPa (Variolink II). Two-way ANOVA showed statistically significant differences among adhesive systems (P < .05) and root regions (P < .05). The bond strengths of One-step and Variolink II groups were statistically higher than those of RelyX and Panavia F groups. The bond strengths of the cervical region of One-step and Panavia F groups were statistically significantly higher than those of the other two regions. The SEM images showed uniform and long resin tags in One-step and Variolink II groups, whereas few or no resin tags were visible in the other two groups., Conclusion: The type of adhesive system and root region had a significant influence on the bond strengths of the adhesively luted fiber posts. Total-etching technique achieved better bond strength than did the self-etching technique.

Among the factors that influence the success of treatment of a root perforation, its location and possibility of contamination are determinant because the interaction of these 2 factors may result in significant periodontal injury. The management of cases of hard-to-reach contaminated perforations depends on the choice of an adequate technique. In the case reported in this article, controlled orthodontic tooth extrusion was successfully performed to treat gingival recession secondary to root perforation. The outcomes showed that this technique preserves the zone of attached gingiva, maintains the crown height, and prevents the involvement of the supporting bone tissue. The favorable clinical and radio?graphic conditions after 7 years of follow-up demonstrate the viability of this treatment approach.

Objective: To evaluate the speed (efficiency) and effectiveness of 3 different fiber post removal systems., Method and Materials: Fiber posts (D.T. Light-Post no. 1 [Bisco Dental] and ParaPost FiberLux no. 5 [Coltène/Whaledent]) were cemented into 60 single-rooted teeth after endodontic therapy and post space preparation were completed. Three methods of fiber post removal were evaluated-D.T. Light-Post removal kit, the Kodex twist/Tenax ParaPost fiber post removal drill kit, and a combination of diamond bur/Peeso reamer., Results: The efficiency to remove either fiber post was not significantly different, nor was efficiency of any of the 3 post removal systems significantly different. For effectiveness, no difference was observed between post types, but effectiveness was higher with the diamond bur/Peeso reamer compared with the Kodex twist/Tenax ParaPost drills, which in turn was more effective than the D.T. Light-Post removal kit., Conclusions: Fiber posts are efficiently removed by all 3 methods, but effectiveness of removal is higher using the diamond bur/Peeso reamer.

Objective: To evaluate the effect of the activation mode of adhesive cementation on push-out bond strength of fiber-reinforced resin posts to root canal dentin., Method and Materials: Forty mandibular premolars were endodontically treated and randomly divided into 4 equal groups. In groups G-1, G-2, and G-3, Single Bond (3M Espe) was applied and light polymerized for 20 seconds; in group G-4, Scotchbond Multi-Purpose Plus (3M Espe) was used as an autopolymerized adhesive. The dual-cure resin cement Rely X ARC (3M Espe) was light polymerized in G-2 and G-3 but not in G-1 and G-4. The translucent post Light-Post (Bisco) was used in G-3 and the opaque post Aestheti-Plus (Bisco) in the other groups. The roots were sectioned in 3 parts (cervical, middle, apical); each slice was submitted to the push-out test at a crosshead speed of 0.5 mm/min. Data were analyzed by analysis of variance and Tukey test (a = .05)., Results: Light polymerization of both the adhesive and resin cement in G-2 led to significantly higher bond strength than in G-1, where only the adhesive was light polymerized. No difference was found between G-2 (opaque post) and G-3 (translucent post). The autopolymerized adhesive showed the highest bond strength in all root regions. The middle and apical post/root regions had similar bond strength, but it was significantly lower than that in the cervical region (P <.001)., Conclusion: Bond strength to root dentin varied as a function of the activation mode of post adhesive cementation and post/root regions.

Objective: The purpose of this in vitro investigation was to evaluate the fracture strength of endodontically treated teeth restored with different all-ceramic posts and cores., Method and Materials: Seventy-two endodontically treated human maxillary central incisors were divided into 3 groups with 24 teeth each and restored with 1 of the following methods: prefabricated zirconia ceramic posts and resin composite buildups; zirconia ceramic posts and copy-milled alumina ceramic cores (2-piece technique), or copy-milled all-ceramic posts and cores made from a zirconia-reinforced glass-infiltrated alumina ceramic (1-piece technique). Each group was divided into 3 subgroups of 8 samples each, consisting of teeth that did not receive crown restorations and were stored for 60 days, teeth restored with all-ceramic crowns and stored for 60 days, and teeth restored with all-ceramic crowns and subjected to 1.2 million loading cycles with 30 N in a chewing simulator., Results: The mean fracture strengths ranged from 205 to 522 N. Prefabricated zirconia posts and resin composite buildups showed a statistically significantly lower fracture strength after chewing simulation than teeth restored with prefabricated zirconia posts and alumina ceramic cores., Conclusion: All-ceramic posts and cores made with the 2-piece technique showed promising fracture strengths under the tested conditions.

Objective: To compare the application of ultrasound with the use of an engine-driven trephine bur to remove parallel-sided root canal posts., Method and Materials: Single-rooted human canine teeth were decoronated and prepared to receive preformed titanium posts. The posts were cemented with Panavia F resin cement. Ten teeth acted as controls, 10 had a 4-mm-deep gutter cut around the post using a Masserann trephining bur, and 10 were subjected to 10 minutes of ultrasound. The forces required to dislodge the posts were determined using a universal testing machine, and the data were analyzed using analysis of variance., Results: The only significant difference was between the trephined and ultrasonically energized groups, with the ultrasonic group requiring greater forces for dislodgement., Conclusion: Resin composite cement could be removed from around the posts with the trephine bur but with considerable difficulty, and neither method of dislodging the posts was effective.

Objectives: The combination of an individually cast core and a prefabricated metal post is one of the many techniques to restore endodontically treated teeth. The surface characteristics of commercially available posts vary considerably and likely influence retention. In this study, the surface configuration of 11 castable prefabricated post systems and their retention at the post-cement interface were investigated., Method and Materials: Scanning electron microscopic photos were made to assess surfaces of the posts. Etchant residues or applied surface layers were also analyzed with an electron beam microprobe. For the retention measurements, 6 posts from each system were cemented in artificial root canals with a zinc phosphate cement. Retention was measured on a universal testing machine., Results: Analysis of variance and the Ryan-Einot-Gabriel-Welsch F test revealed significant differences in retention between posts; these differences were related to the microstructure of the surfaces of the posts. In general, the coarser the surfaces, the better the retention. Gold plating of the etched surface for one manufacturer resulted in less retention compared to posts of the same type and size that were not plated., Conclusion: The surface configuration of a post could be an important factor when selecting a prefabricated post system.

The dowel-and-core restoration is indicated when inadequate tooth structure remains to retain an extracoronal restoration. A modified technique for fabricating the dowel and core combines the direct technique of forming the dowel in the actual channel with the indirect technique of creating an ideal core contour in the laboratory. This technique allows the operator to create an accurate and passive fit of the dowel pattern in the canal preparation. The technique also introduces the option of retrieving the dowel portion by utilizing a polyvinyl siloxane cast or liner. Further advantages of the technique are reduced chairside time and the ability to capitalize on the preparation of multiple teeth. The technique focuses efforts on achieving an accurate and passive fit of the dowel clinically while delegating the formation of the core to the laboratory.

Objective: The purpose of this study was to evaluate the resistance of selected post-and-core systems to fatigue testing., Method and Materials: A fatigue-testing machine and data acquisition software were developed for this in vitro test. Pulpless mandibular second premolars were treated with three different types of post-and-core system: (1) two different prefabricated posts with amalgam cores, (2) the same two prefabricated posts with resin composite cores, and (3) cast post and cores, which served as the control group. The fatigue-testing machine applied alternating buccal and lingual forces to the core until lateral movement of 0.0025 inches (63.5 microns) was detected by a transducer contacting the surface of the core. This criterion represented initial cement failure., Results: Although groups using the resin composite core material exhibited a higher number of cycles prior to failure, there was no statistically significant difference between the different post-and-core systems., Conclusion: All of the post-and-core systems that were tested may be acceptable for restoring endodontically treated teeth.

Because of their unique radicular anatomy, mandibular molars require careful treatment planning for post-and-core fabrication. Indications for post-and-core fabrication for endodontically treated mandibular molars are discussed, and immediate and cast post-and-core techniques are reviewed. An alternative design for a cast post and core is also presented.

Selecting the optimum prefabricated post-and-core system can be a complex and imprecise exercise for the restorative dentist. First, no single prefabricated post-and-core system fits all situations. Second, the vast number of post-and-core components currently on the market complicates the selection process. Finally, useful biomechanical criteria for evaluating prefabricated post-and-core components are difficult to quantify. The prefabricated post-and-core system consists of three components: the post, a core material, and a luting cement. Each combination of component types is a potential system alternative. This article presents useful biomechanical criteria, based on current restorative guidelines, for evaluating the basic components of any prefabricated post-and-core system.

This article describes a build-up technique that uses a customized acrylic resin shell for restoring endodontically treated molars that are involved in three-unit fixed partial denture design. The shell confines the amalgam without impinging on the periodontium to ensure a proper core foundation, an ideal tooth preparation, and a more predictable final restoration.

A perforated root represents a difficult challenge to the clinician, and treatment of such defects often involves surgical and/or advanced restorative techniques. This typically requires a series of lengthy, often stressful appointments, may compromise esthetics, and invariably involves additional costs to the patient. This case report describes the nonsurgical treatment of separate mechanical perforations that resulted from the removal of a failed prefabricated post. The tooth was restored in a minimum number of visits through the use of a novel application of a resin-ionomer material originally designed for routine restorative procedures.

A multidisciplinary panel of senior academics and practitioners has evaluated a system of prefabricated threaded split-shank posts (Flexi-Post/Flexi-Flange) from published research and their own clinical use. These posts have been compared with requirements of an ideal post system in relation to clinical use, stress effects, stress distribution, retention, loosening and displacement, provision for cores, and biocompatibility. The purpose was to provide this critical review to allow interested clinicians to compare this novel design to other available post systems.

An injection technique can be used to rapidly generate direct post and core patterns with autopolymerizing acrylic resin. The technique uses an autopolymerizing acrylic resin, a serrated plastic pin, and a syringe with a disposable needle tube and plug to inject acrylic resin into the root canal. The technique is simple, accurate, and faster than the bead-brush technique and eliminates some of its shortcomings.

The intraradicular reinforcement of structurally compromised roots has been advocated for endodontically treated teeth with thin remaining walls. The purpose of this in vitro study was to investigate the validity of intraradicular reinforcement. After the crowns were removed, forty structurally weakened central incisors were divided into two main groups for morphologic dowel rehabilitation or resin reinforcement and dowel rehabilitation. Within both these groupings, half the specimens were ferruled to assess the effects of a ferrule on fracture resistance. All dowels were cemented with resin cements. The resistance to a simulated masticatory load of a resin-reinforced post and core system was significantly greater than that of a morphologic post and core procedure. When a bonded resin reinforcement and dowel cementation was used on structurally weakened roots, there was no statistically significant difference between post and core restorations that used a ferrule and those without a ferrule.

This in vitro study compared physical properties of root canal posts made of carbon fiber-reinforced epoxy resin with those of stainless steel posts. Three-point bending tests were used to derive the transverse modulus of elasticity of the posts. Resin composite cores on the posts were subjected to tensile forces to test the bonds between the cores and posts. Carbon fiber posts appeared to have adequate rigidity for their designed purpose. The bond strength of the resin composite cores to the carbon fiber posts was significantly less than that to the stainless steel posts.

Forty acrylic resin duplicates of an endodontically treated and extracted human molar were restored with two resin composite materials for core restorations. Two different manipulation techniques, bulk insertion and syringe application, were used. In a simulated clinical setup, the core buildups produced by the different manipulation techniques were investigated for voids. In 20 duplicates, a post was placed to simulate a metal post and resin composite core buildup. The syringe technique produced significantly fewer incorporated voids for both resin composite core materials than did the bulk insertion technique. It was not possible to demonstrate a relationship between the presence of voids and the presence of a metal post.

Electrolytic corrosion is part of a broader electrochemical phenomenon that is responsible for oral galvanism. Because several physiopathologic manifestations are associated with the electrochemical phenomenon of galvanism, making the differential diagnosis can be difficult. In endodontically treated teeth, periapical electrolytic corrosion phenomena with associated symptoms can easily be misinterpreted, and the clinical presentation may be accepted as a diagnosis rather than a symptom. The purpose of this paper is to describe two cases of symptomatic periapical electrolytic corrosion resulting from the creation of "active" bimetallic galvanic cells involving silver points. The treatment involved the placement of a retrograde seal into the apical part of the root canal, which controlled the unwanted effect of leakage into the canal space. With the electrochemical activity attenuated, periapical healing and remission of symptoms occurred.

This article describes a technique for fabricating a custom acrylic resin shell that will ensure a properly designed amalgam core for the coronally debilitated, endodontically treated posterior tooth. A few simple procedures result in a core foundation for root protection, an ideal crown preparation, and a more predictable final restoration.

Composite resins have been advocated as a reinforcing build-up material for badly damaged endodontically treated teeth with flared canals. However, the control of an autocuring composite resin is difficult because it polymerizes rapidly within the root canal. While the light-curing composite resins are more user friendly, their polymerization can be a problem deep in the root canal. Light-transmitting plastic posts allow the transmission of light into the root canal and enable intraradicular composite resin reconstitution and reinforcement of weakened roots. At the same time, the light-transmitting plastic post forms an optimal post canal in the rehabilitated root and can accurately fit a matching retentive final post. These light-transmitting posts are a useful addition to the dental armamentarium.

This paper describes the combined efforts of an orthodontist, periodontist, and a restorative dentist to save an unrestorable tooth by clinical crown lengthening. A maxillary lateral incisor, originally treatment planned for extraction, was treated with orthodontic extrusion, circumferential fiberotomy, and metal-ceramic crown restoration. To maximize the esthetic appearance of the tooth during orthodontic treatment, an acrylic resin facing was designed together with the orthodontic appliance used to facilitate vertical extrusion. Clinical crown lengthening may be used as an alternative approach to the treatment of severely broken down anterior teeth.

In vitro tests and a clinical examination of 51 patients who were treated over a period of 12 years have demonstrated that a composite resin core that is surrounded by a gold crown may provide the same function and strength as a conventional gold core. However, the method demands a thorough knowledge of the materials and a careful and detailed technique. The importance of an initially effective dentinal bond to the chosen hybrid composite resin is stressed. Zinc phosphate cements and the technique of cementing are also discussed. In most cases, a damaged root will have to be reinforced with a post, and the author recommends the use of a threaded titanium post that fits well and is bound to the root with a so-called passive cementation technique. The author has also had positive experiences with composite resin crowns, which can be expected to have a functional life of at least 10 years.

In this series of case reports, unusual clinical procedures in the implementation of post and core restorations are demonstrated and their difficulties are discussed. First a method for preparing an immediate post and amalgam core, while utilizing the provisional self-curing acrylic resin crown as a matrix for the condensation of amalgam, is presented. The second technique is the fabrication of a cast post and core restoration that fits an abutment root as well as the existing crown of a four-unit fixed restoration. The third case illustrates the clinical procedures involved in preparing an immediate post and core restoration through an opening in the crown, when the extended fixed restoration cannot be removed.