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It is unclear whether endodontically treated, single-rooted teeth need cast or direct posts and cores
ARTICLE
THERAPY
It is unclear whether endodontically treated, single-rooted teeth need cast or direct posts and cores
ANALYSIS & EVALUATION
Heydecke G, Peters MC. The restoration of endodontically treated, single-rooted teeth with cast or direct posts and cores: a systematic review. J Prosthet Dent 2002;87:380-6.
5
This systematic review evaluated the published literature reporting success rates of endodontically treated, single-rooted teeth restored with cast versus direct posts and cores, both in vitro and in vivo. Note: Only the human studies will be addressed in this review. Not available
Systematic review of in vitro and in vivo studies; systematic review of several case series
Original Article
Level of Evidence
Purpose
Source of Funding
Type of Study/Design
Summary STUDIES Six different samples, 1 from each study that satisfied review inclusion criteria. EXPOSURE The type of post-and-core restoration, ie, cast versus direct.
MAIN RESULTS Among the 6 studies reviewed, success rates ranged from 87% to 93% for cast restorations and from 68% to 93% for direct restorations. Follow-up times ranged from 3 to 8 years, and definitions of failure varied among studies.
MAIN OUTCOME MEASURE “Success,” defined differently in different studies.
J Evid Base Dent Pract 2003;1:13-4 © 2003 Mosby, Inc. All rights reserved. doi:10.1067/med.2003.14
13
Commentary CONCLUSIONS No conclusive evidence favors cast over direct postand-core restorations or vice versa. The body of literature on the clinical success of post-retained cores is scarce. Randomized controlled trials are needed. ANALYSIS This systematic review clearly identifies the issue under study and the criteria for inclusion in the review. Specifically, a combination of keywords and subject headings in MEDLINE and EMBASE were used to identify an original group of 1773 publications, of which none were randomized trials of post-and-core restorations. Only 6 published studies met the review inclusion criteria, which were (1) a follow-up period of at least 3 years; (2) anterior teeth that could be identified separately; (3) complete-crown restorations, including FPD abutments; (4) a description of the postand-core systems tested; and (5) information about detectable survival or success of the selected teeth. It has long been thought that cast post-and-core restorations offer the best long-term restorative therapy for severely broken-down, endodontically treated anterior teeth. However, improvements in restorative materials and the desire of both patients and dentists to avoid a 2-visit procedure make a systematic comparison between cast and direct post-and-core restorations a valuable one. The lack of clinical evidence on performance is clear, with only 6 studies qualifying for this review, none of which were randomized controlled trials. In fact, 5 of the 6 studies meeting review inclusion criteria did not compare the 2 restorative techniques at
all: 3 were case series descriptions of cast restorations and 2 were case series descriptions of direct restorations. Only 1 study reported on success of both restoration types, showing about 90% success in both groups over a period of 3 years. Direct post-and-core restorations hold a clear advantage over cast restorations in terms of cost and convenience, and should be the procedure of choice if the clinical performance of the 2 types of foundations is shown to be similar. The current lack of clinical evidence points toward the need for well-designed randomized controlled trials. If undertaken, such studies should meet the following criteria: • Adequate statistical power, with a clear definition of whether the trial is designed to test superiority or equivalence. In order to generate adequate study power, a “clinically important difference” must be identified, and choosing this difference necessarily will be a subjective process. • Several definitions of success, including recementation of the restoration, horizontal root fracture, and vertical root fracture. In addition, whether or not the tooth is deemed restorable following “failure” should be stated, since this clearly has clinical implications. • Attention to quality-of-life issues as well as “success,” eg, taking into account patient values regarding a 1- versus 2-visit procedure. Reviewer: Dan Caplan, DDS, PhD School of Dentistry, University of North Carolina Chapel Hill
Notes:
14 Heydecke and Peters
Journal of Evidence-Based Dental Practice March 2003
THERAPY
It is unclear whether endodontically treated, single-rooted teeth need cast or direct posts and cores
ANALYSIS & EVALUATION
Heydecke G, Peters MC. The restoration of endodontically treated, single-rooted teeth with cast or direct posts and cores: a systematic review. J Prosthet Dent 2002;87:380-6.
5
This systematic review evaluated the published literature reporting success rates of endodontically treated, single-rooted teeth restored with cast versus direct posts and cores, both in vitro and in vivo. Note: Only the human studies will be addressed in this review. Not available
Systematic review of in vitro and in vivo studies; systematic review of several case series
Original Article
Level of Evidence
Purpose
Source of Funding
Type of Study/Design
Summary STUDIES Six different samples, 1 from each study that satisfied review inclusion criteria. EXPOSURE The type of post-and-core restoration, ie, cast versus direct.
MAIN RESULTS Among the 6 studies reviewed, success rates ranged from 87% to 93% for cast restorations and from 68% to 93% for direct restorations. Follow-up times ranged from 3 to 8 years, and definitions of failure varied among studies.
MAIN OUTCOME MEASURE “Success,” defined differently in different studies.
J Evid Base Dent Pract 2003;1:13-4 © 2003 Mosby, Inc. All rights reserved. doi:10.1067/med.2003.14
13
Commentary CONCLUSIONS No conclusive evidence favors cast over direct postand-core restorations or vice versa. The body of literature on the clinical success of post-retained cores is scarce. Randomized controlled trials are needed. ANALYSIS This systematic review clearly identifies the issue under study and the criteria for inclusion in the review. Specifically, a combination of keywords and subject headings in MEDLINE and EMBASE were used to identify an original group of 1773 publications, of which none were randomized trials of post-and-core restorations. Only 6 published studies met the review inclusion criteria, which were (1) a follow-up period of at least 3 years; (2) anterior teeth that could be identified separately; (3) complete-crown restorations, including FPD abutments; (4) a description of the postand-core systems tested; and (5) information about detectable survival or success of the selected teeth. It has long been thought that cast post-and-core restorations offer the best long-term restorative therapy for severely broken-down, endodontically treated anterior teeth. However, improvements in restorative materials and the desire of both patients and dentists to avoid a 2-visit procedure make a systematic comparison between cast and direct post-and-core restorations a valuable one. The lack of clinical evidence on performance is clear, with only 6 studies qualifying for this review, none of which were randomized controlled trials. In fact, 5 of the 6 studies meeting review inclusion criteria did not compare the 2 restorative techniques at
all: 3 were case series descriptions of cast restorations and 2 were case series descriptions of direct restorations. Only 1 study reported on success of both restoration types, showing about 90% success in both groups over a period of 3 years. Direct post-and-core restorations hold a clear advantage over cast restorations in terms of cost and convenience, and should be the procedure of choice if the clinical performance of the 2 types of foundations is shown to be similar. The current lack of clinical evidence points toward the need for well-designed randomized controlled trials. If undertaken, such studies should meet the following criteria: • Adequate statistical power, with a clear definition of whether the trial is designed to test superiority or equivalence. In order to generate adequate study power, a “clinically important difference” must be identified, and choosing this difference necessarily will be a subjective process. • Several definitions of success, including recementation of the restoration, horizontal root fracture, and vertical root fracture. In addition, whether or not the tooth is deemed restorable following “failure” should be stated, since this clearly has clinical implications. • Attention to quality-of-life issues as well as “success,” eg, taking into account patient values regarding a 1- versus 2-visit procedure. Reviewer: Dan Caplan, DDS, PhD School of Dentistry, University of North Carolina Chapel Hill
Notes:
14 Heydecke and Peters
Journal of Evidence-Based Dental Practice March 2003