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Restoring endodontically treated teeth
Restorative Dentistry Restoring endodontically treated teeth Background.—Many factors contribute to or compromise the survival of endodontically treated and restored teeth. Among the key factors are the amount of coronal structure remaining, the restorative procedures done, and the selection of material. The 4-year survival of root-filled premolars was investigated to determine if it was affected by the amount of residual coronal structure and the type of cement used for fiber post luting.
Results.—The highest survival (100%) and success (90.0%) rates were achieved by teeth with more than 50% of coronal structure remaining and posts luted with core material. The lowest survival (86.6%) and success (63.3%) rates were found in teeth with 50% or less of residual coronal structure and fiber posts luted with self-adhesive cement. Periapical lesions and post debonding caused most of the failures, although root fractures were noted after 3 and 4 years of service.
Methods.—Sixty patients were divided into two groups based on the amount of residual coronal dentin after abutment build-up (more or less than 50% of coronal residual structure) and final preparation (equal to or less than 50% of coronal residual structure). Teeth were randomly assigned to two subgroups according to the material used for luting the fiber posts, specifically, a resin core build-up material or a self-adhesive universal cement (Table 1). Success was defined on the basis of clinical and intra-oral radiographic evaluations 6, 12, 24, 36, and 48 months after completing the restoration.
Statistical analysis revealed neither the amount of residual coronal structure nor the restoration material significantly altered restoration failure risk. Additionally, no significant effect was attributable to factor interaction. There were no statistically significant differences between the groups. Discussion.—The risk of failure in endodontically treated and fiber post restored premolars was not dependent on either the amount of residual coronal structure or the luting agent used over the course of 4 years of follow-up. This is the first clinical trial evaluating the effect of the amount of coronal tooth structure
Table 1.—Detailed Description of Clinical Procedures Followed in Endodontic Treatment and Post Space Preparation Endodontic Treatment - Endodontic treatment was performed under rubber dam isolation. - Canal instrumentation with K-files (#8-10-15, Dentsply Maillefer, Ballaigues, Switzerland) and Flexmaster rotary instruments (#15-20-25-30-35-40; VDW, Munich, Germany) mounted on the endodontic motor (Endo IT professional, Aseptico Inc., Woodinville, WA, USA) to a working length of 0.5 mm from the apex. - Irrigation with 5.25% sodium hypochlorite with a long 27-gauge needle at each change of instrument. - Final rinse with deionized water and patency of the canal maintained with a #10 K-file. - Drying the canals with multiple paper points. - Obturation with gutta-percha by the continuous wave technique up to 4 to 5 mm from the apex with a System B heat source (SybronEndo, Orange, CA, USA); root canal sealer was AH26 (Dentsply Maillefer, Ballaigjes, Switzerland). - Backfilling of the canals with thermoplastic gutta-percha from Obtura II Unit (Obtura Corp., Fenton, MO, USA). - Sealing the canal access with glass- ionomer cement (Fuji IX, GC Corp., Tokyo, Japan). Post Space Preparation - Removing the temporary coronal seal at least 24 hr after endodontic treatment. - Preparation of post spaces 7 to 8 mm in depth with pre-calibrated drills provided by the manufacturer (GC Corp.); at least 4 mm of intact apical seal left. - Cleaning the post space with water by means of a long 27-gauge needle. - Choosing post size for best fit of the diameter of the canal (diameter of the post, 1.2 mm, 1.4 mm, or 1.6 mm). - Checking the post fit and shortening with a diamond bur to ail adequate length - Pre-treating the post with a silane coupling agent (GC Ceramic Primer, GC Corp.). (Courtesy of Juloski J, Fadda GM, Monticelli F, et al: Four-year survival of endodontically treated premolars restored with fiber posts. J Dent Res 93:52S-58S, 2014.)
Volume 59
Issue 6
2014
e143
remaining after abutment preparation in endodontically treated teeth.
Clinical Significance.—Over the course of 4 years, the risk of failure of teeth that had been endodontically treated and then restored with a fiber-post restoration increased when there was less coronal structure remaining. However, clinical performance was not altered by the material used for luting posts, with resin core
e144
Dental Abstracts
material and self-adhesive resin cement performing equally well.
Juloski J, Fadda GM, Monticelli F, et al: Four-year survival of endodontically treated premolars restored with fiber posts. J Dent Res 93:52S-58S, 2014 Reprints available from the Journal of Dental Research; e-mail: http:// www.sagepub.com/journalsReprints.nav
Results.—The highest survival (100%) and success (90.0%) rates were achieved by teeth with more than 50% of coronal structure remaining and posts luted with core material. The lowest survival (86.6%) and success (63.3%) rates were found in teeth with 50% or less of residual coronal structure and fiber posts luted with self-adhesive cement. Periapical lesions and post debonding caused most of the failures, although root fractures were noted after 3 and 4 years of service.
Methods.—Sixty patients were divided into two groups based on the amount of residual coronal dentin after abutment build-up (more or less than 50% of coronal residual structure) and final preparation (equal to or less than 50% of coronal residual structure). Teeth were randomly assigned to two subgroups according to the material used for luting the fiber posts, specifically, a resin core build-up material or a self-adhesive universal cement (Table 1). Success was defined on the basis of clinical and intra-oral radiographic evaluations 6, 12, 24, 36, and 48 months after completing the restoration.
Statistical analysis revealed neither the amount of residual coronal structure nor the restoration material significantly altered restoration failure risk. Additionally, no significant effect was attributable to factor interaction. There were no statistically significant differences between the groups. Discussion.—The risk of failure in endodontically treated and fiber post restored premolars was not dependent on either the amount of residual coronal structure or the luting agent used over the course of 4 years of follow-up. This is the first clinical trial evaluating the effect of the amount of coronal tooth structure
Table 1.—Detailed Description of Clinical Procedures Followed in Endodontic Treatment and Post Space Preparation Endodontic Treatment - Endodontic treatment was performed under rubber dam isolation. - Canal instrumentation with K-files (#8-10-15, Dentsply Maillefer, Ballaigues, Switzerland) and Flexmaster rotary instruments (#15-20-25-30-35-40; VDW, Munich, Germany) mounted on the endodontic motor (Endo IT professional, Aseptico Inc., Woodinville, WA, USA) to a working length of 0.5 mm from the apex. - Irrigation with 5.25% sodium hypochlorite with a long 27-gauge needle at each change of instrument. - Final rinse with deionized water and patency of the canal maintained with a #10 K-file. - Drying the canals with multiple paper points. - Obturation with gutta-percha by the continuous wave technique up to 4 to 5 mm from the apex with a System B heat source (SybronEndo, Orange, CA, USA); root canal sealer was AH26 (Dentsply Maillefer, Ballaigjes, Switzerland). - Backfilling of the canals with thermoplastic gutta-percha from Obtura II Unit (Obtura Corp., Fenton, MO, USA). - Sealing the canal access with glass- ionomer cement (Fuji IX, GC Corp., Tokyo, Japan). Post Space Preparation - Removing the temporary coronal seal at least 24 hr after endodontic treatment. - Preparation of post spaces 7 to 8 mm in depth with pre-calibrated drills provided by the manufacturer (GC Corp.); at least 4 mm of intact apical seal left. - Cleaning the post space with water by means of a long 27-gauge needle. - Choosing post size for best fit of the diameter of the canal (diameter of the post, 1.2 mm, 1.4 mm, or 1.6 mm). - Checking the post fit and shortening with a diamond bur to ail adequate length - Pre-treating the post with a silane coupling agent (GC Ceramic Primer, GC Corp.). (Courtesy of Juloski J, Fadda GM, Monticelli F, et al: Four-year survival of endodontically treated premolars restored with fiber posts. J Dent Res 93:52S-58S, 2014.)
Volume 59
Issue 6
2014
e143
remaining after abutment preparation in endodontically treated teeth.
Clinical Significance.—Over the course of 4 years, the risk of failure of teeth that had been endodontically treated and then restored with a fiber-post restoration increased when there was less coronal structure remaining. However, clinical performance was not altered by the material used for luting posts, with resin core
e144
Dental Abstracts
material and self-adhesive resin cement performing equally well.
Juloski J, Fadda GM, Monticelli F, et al: Four-year survival of endodontically treated premolars restored with fiber posts. J Dent Res 93:52S-58S, 2014 Reprints available from the Journal of Dental Research; e-mail: http:// www.sagepub.com/journalsReprints.nav