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Selecting an appropriate coronal restoration after root canal treatment requires careful consideration, however, there is a lack of established web-based tool that is based on clear guidelines for suitable post-endodontic restorations. Hence, we aimed to design and determine the acceptability of an interactive application to aid the decision making process for post-endodontic restoration among the undergraduate dental students. A web-based post-endodontic restoration decision making interactive application, (RestoSmart) was developed after a detailed review of available literature. Seventy undergraduate dental students of IMU University were recruited in the study. A validated questionnaire was given to the participants before and after the use of RestoSmart to answer the provided mock clinical scenarios. Obtained data were statistically analyzed using IBM SPSS version 26 software package. The statistical analysis demonstrated that RestoSmart was acceptable among the undergraduate dental students (P < 0.05). Initially, participants recognized the potential benefits of designing an interactive application, 74% believing that it may enhance decision making and 76% emphasizing its user-friendliness. Additionally, close to half of the participants expressed the willingness to use interactive tools in future. Following the use of RestoSmart , there was a notable increase in favorability, with 94.2% finding it helpful in the decision making and 94.3% acknowledging its user-friendliness. Furthermore, 87.2% expressed intent to use RestoSmart in future. RestoSmart was useful for decision making and user friendly. While overall response was positive, there exist some areas for improvement such as ease of use, updating evidence-based guidelines, and establishing its helpfulness in teaching and learning. [ABSTRACT FROM AUTHOR]

Background/Purpose: Selecting an appropriate coronal restoration after root canal treatment requires careful consideration, however, there is a lack of established web-based tool that is based on clear guidelines for suitable post-endodontic restorations. Hence, we aimed to design and determine the acceptability of an interactive application to aid the decision making process for post-endodontic restoration among the undergraduate dental students. Materials and methods: A web-based post-endodontic restoration decision making interactive application, (RestoSmart) was developed after a detailed review of available literature. Seventy undergraduate dental students of IMU University were recruited in the study. A validated questionnaire was given to the participants before and after the use of RestoSmart to answer the provided mock clinical scenarios. Obtained data were statistically analyzed using IBM SPSS version 26 software package. Results: The statistical analysis demonstrated that RestoSmart was acceptable among the undergraduate dental students (P

(1) Background: Non-surgical endodontic treatment has been shown to be clinically successful; however, clinical long-term data are scarce. This practice-based retrospective clinical investigation evaluated endodontic outcomes over 40 years and identified relevant clinical co-factors. (2) Methods: Two experienced dental practitioners in two different private dental practices treated 174 patients with 245 teeth from 1969 to 1993. After root canal obturation, either a new direct restoration (amalgam, resin composite, or glass-ionomer cement) or the re-cementation of a pre-existing prosthetic restoration or renewal of prosthetic restoration followed. Metal posts (operator A) or metal screws (operator B) were inserted when coronal substance loss was significant. The primary outcome (i.e., tooth survival) was achieved when the endodontically treated tooth was, in situ, painless and had full function at the end of the observation period. A secondary outcome, the impact of different prognostic factors on survival rate, was evaluated. (3) Results: The overall mean survival was 56.1% of all treated teeth after 40 years of clinical service, resulting in an annual failure rate of 1.1%. Most investigated clinical co-factors (jaw, tooth position, intracanal dressings, post/screw placement, and gender) showed no significant influence on survival. (4) Conclusions: Even with materials and techniques from the 1970s and 1980s, successful root canal treatment was achievable. Except for post-endodontic restorations, most of the evaluated factors had no significant influence on the clinical long-term survival of root canal-treated teeth. [ABSTRACT FROM AUTHOR]

This in vitro study was conducted to evaluate and compare the fracture resistance of endodontically treated teeth using different post-obturation restorative materials. Seventy-five non-carious extracted human teeth were collected. Access opening, chemicomechanical preparation, and obturation were done. Teeth were randomly divided into various groups depending on the type of post-endodontic restoration: group I—control group, group II—Tetric-N-Flow Bulk Fill, group III—Tetric-N-Flow Bulk Fill + everX Posterior, group IV—P60, and group V—P60 + everX Posterior. The fracture resistance of each sample was measured using the universal testing machine. Results: The results obtained were subjected to statistical analysis. This demonstrated that group III (Tetric-N-Flow Bulk Fill + everX Posterior) was shown to be the most effective group followed by group V (Filtek P60 + everX Posterior) out of all of the other restorative experimental groups. Conclusion: Tetric-N-Flow Bulk Fill + everX Posterior showed maximum fracture resistance among the experimental groups.

Background: Classic endocrowns made of dental ceramics are considered a promising alternative to traditional post-endodontic restorations. The use of circular ferrules in endocrowns is a topic of controversial discussion. Therefore, the present study aims to evaluate the effect of ferrule design and cementation mode on the fatigue resistance of zirconia endocrowns. Methods: Eighty human molars were divided into four groups (n = 20): NFC (no-ferrule, conventional cementation), NFA (no-ferrule, adhesive luting), FC (ferrule, conventional cementation) and FA (ferrule, adhesive luting). Both the classic and the modified endocrown preparation with a two-millimeter ferrule design were carried out. Endocrowns were fabricated from zirconia using the CEREC system. After thermocycling, specimens were loaded according to the step-stress test up to 1500 N. Results: Failure rate was low; 88.8% of total specimens passed the step-stress test. Fractures were distributed between all groups; no significant differences in fatigue resistance were detected for preparation design and cementation mode. Conclusions: Endocrowns appear to be a promising concept for endodontically treated molars. Ferrule and also cementation mode have only a minor influence on fatigue resistance of zirconia endocrowns. However, at very high forces, the marginal area of the ferrule represents a weak point. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case highlights where a metal endocrown was used as a novel technique. The metal endocrown showed promising outcomes during the 5‐year follow‐up, utilizing a resin base to preserve tissue and act as a stress breaker. This approach was used to preserve the tooth and avoid extraction or periodontal surgery. [ABSTRACT FROM AUTHOR]

This in vitro study was conducted to evaluate and compare the fracture resistance of endodontically treated teeth using different post-obturation restorative materials. Seventy-five non-carious extracted human teeth were collected. Access opening, chemicomechanical preparation, and obturation were done. Teeth were randomly divided into various groups depending on the type of post-endodontic restoration: group I—control group, group II—Tetric-N-Flow Bulk Fill, group III—Tetric-N-Flow Bulk Fill + everX Posterior, group IV—P60, and group V—P60 + everX Posterior. The fracture resistance of each sample was measured using the universal testing machine. Results: The results obtained were subjected to statistical analysis. This demonstrated that group III (Tetric-N-Flow Bulk Fill + everX Posterior) was shown to be the most effective group followed by group V (Filtek P60 + everX Posterior) out of all of the other restorative experimental groups. Conclusion: Tetric-N-Flow Bulk Fill + everX Posterior showed maximum fracture resistance among the experimental groups. [ABSTRACT FROM AUTHOR]

Recent formulations of resin-based composites have incorporated different combinations of materials. However, the mechanical and bonding behavior of these materials with intraradicular posts are unclear. This study aimed to evaluate the effect of light-cure and dual-cure resin composite posts on the fracture resistance of endodontically-treated teeth. Materials and Methods: Ninety extracted human upper canines were selected and randomly divided into nine groups (n=10): (G1) endodontically treated teeth without endodontic posts; (G2) glass-fiber post cemented with glass-ionomer cement; (G3) endodontic post by dual-cure composite resin (Rebilda DC); (G4) endodontic post by dual-cure composite resin (Cosmecore); (G5) endodontic post by dual-cure composite resin (Bis-Core); (G6) endodontic post by light-cure composite resin; (G7) glass-fiber post customized with flowable composite resin; (G8) glass-fiber post cemented with light-cure composite resin; (G9) glass-fiber post cemented with self-adhesive resin cement. After the post insertion, all specimens were subjected to mechanical (250,000 cycles) and thermocycling (6000 cycles, 5 °C/55 °C) and immediate loading at 45 degrees in a universal testing machine until fracture. The data were analyzed by one-way ANOVA and multiple comparisons using the Fisher LSD Method (p < 0 05). Results: The mean failure loads (±SD) for the groups ranged from 100.7 ± 22.6 N to 221.9 ± 48.9 N. The G1 group (without endodontic posts) had a higher fracture strength than all experimental groups (p < 0.001). Conclusions: Within the limitations, the light- and dual-cure post technique did not present lower fracture resistance values as compared to the conventional glass-fiber post. [ABSTRACT FROM AUTHOR]

We discuss the aesthetic, biomechanical and technological aspects of post-endodontic restoration of the crown part of the teeth. The expediency and effectiveness of creating a tooth crown part based on a fiberglass-reinforced adhesive composite inlay made by a direct method is substantiated. The criteria for selecting materials for the post-endodontic restoration are considered, and clinical examples are given.

Endodontically treated teeth with compromised coronal tooth structure often require core build-ups with the support of radicular posts. In certain cases, the traditional post and core approach may not be possible due to various anatomical and clinical contraindications. Such cases require more meticulous planning and alternative treatment approaches for successful outcomes. The endocrown technique offers a conservative and minimally invasive approach, providing functional and aesthetic rehabilitation while preserving tooth structure. In this clinical case report, we discuss an endocrown-type restoration made from lithium disilicate ceramic in a maxillary first molar with extensive coronal destruction., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kirthiga et al.)

Background The most popular approach to treating pulpal and periapical disease is endodontic therapy, but the most common failure after root canal therapy, if not followed by planned rehabilitation of the tooth, is tooth fracture, which may be so severe in some cases needing extraction. Inadequate endodontic restorations increase the risk of fracture and coronal leakage, which can disseminate bacteria and their byproducts and perhaps lead to the failure of root canal therapy. In order to offer protection against masticatory forces along with compressive obturation forces that can lead to vertical root fracture, research has also supported the use of post-endodontic treatment restorative materials with an elastic modulus that is either greater or comparable to the tooth itself for post-endodontic restorations. Restorative materials that can bond to root dentin can be used to create intraorifice barriers, which prevent coronal microleakage and reinforce the radicular dentin. The current in vitro study aims to assess the effects of various intraorifice barriers (an alkasite restorative material versus resin-modified glass ionomer cement) on the sealing ability of the intraorifice barriers following root canal therapy. Methodology In vitro, confocal laser microscopy is used to determine the microleakage of various intraorifice barriers. Conclusion The sealing ability of a post-endodontic restoration is crucial for the overall success of endodontic treatment, and this in vitro study protocol would ultimately help in selecting the appropriate intraorifice barrier., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jidewar et al.)

Aim: This study aimed to comparatively evaluate the fracture resistance of different metallic post and core materials. Materials and Methods: Twenty-four maxillary–central incisors were selected, standardized, and segregated into three groups (GP I–III) (n = 8) based on the type of alloy used for post and core preparation. GP I (gold alloy [Au]), GP II (chrome–cobalt alloy [Co–Cr]), and GP III (titanium alloy [Ti]) were comparatively evaluated for use as post and core materials. The teeth were endodontically treated and tooth preparation for post core was done.Metal post and cores were fabricated using indirect wax pattern and luted. Teeth were mounted on resin bases, fracture testing was done, and type of fractures were analyzed. Results: Mesiodistal type of fracture was the most common among experimental groups with a percentage incidence of 54.20%. The comminuted type of fracture was the next most common with a percentage incidence of 29.2%. The incidence of buccolingual, transverse, and other type of fracture was not common and had a percentage incidence of 29.2%, 4.2%, 8.3% and 4.2% respectively. Group II had the highest fracture resistance with a mean value of 742.89N. Group III and Group I had mean values of 482.33 and 361.1123N. Statistically significant difference between experimental groups (I and II) and (II and III) was observed in load values of root fracture (P < 0.05). Conclusion: On the basis of the protocols used and limitations of this study, among metallic post and core materials tested, GP II had the highest fracture resistance values. Further evaluation of these different post and core systems, new alloy formulations designed specifically for use as post and core materials, and assessment in a clinical setting is recommended.

The aim is to evaluate the influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors. 150 maxillary central incisors were divided into three groups, Group 0, intact teeth; Group 1, removal of distal wall; Group 2, removal of mesial and distal walls, and further into two subgroups A0,A1,A2 and B0,B1,B2 according to post-endodontic restoration (post/no-post), then loaded to fracture. Interactions among variables and intergroup significance were tested with two-way ANOVA and Kruskal Wallis's tests (p≤0.05). Tukey's test was applied for multiple comparisons. Statistically significant differences were found between groups B1-A1, and B2-A2, but they were not found between B0-A0. Intragroup analysis showed statistically significant differences in both groups post/no-post with decreasing dental substance. Fiber post placement causes an increase in fracture strength and a reduction of irreparable fractures in endodontically treated maxillary central incisors that lost at least one wall. [ABSTRACT FROM AUTHOR]

Introduction The preservation of tooth structure during cavity preparation is crucial for maintaining tooth strength and longevity of restorations. The biomechanical behavior of teeth, especially those with mesio-occlusal-distal (MOD) cavity preparations, is significantly affected by the extent of cavity preparation and the type of restorative treatment employed. The aim of the current study was to evaluate and analyze the stress distribution seen in the mandibular molar with MOD cavity when restored with transverse post, using finite element analysis (FEA). Materials and methodology FEA was utilized to evaluate stress distribution in an endodontically treated mandibular first molar with MOD cavity preparation, restored using a transverse post and composite restoration. Three-dimensional models incorporating the tooth and the surrounding structures, along with the transverse post and composite restoration, were constructed based on known biomechanical properties. After meshing the models, loads were defined on the buccal and lingual cusps with a constant value of 600N and at an angle of 45 degrees. Preprocessing involved model preparation followed by postprocessing to obtain results representing the degree and type of stress distribution. Results FEA simulations revealed the distribution of stress within the tooth structure under functional occlusal forces. The transverse post system effectively reinforced the tooth by deflecting incident forces and providing uniform stress distribution. von Mises stresses were analyzed to assess the likelihood of material failure. The distribution of the stress in the restored tooth model was comparable to that seen in the intact model. Conclusion Transverse post along with composite restoration provides a conservative and cost-effective alternative to full coverage crowns while providing a functional and aesthetic outcome. Further research and clinical studies are warranted to validate these findings and optimize the clinical application of transverse post systems in restorative dentistry., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rajagopal et al.)

Purpose: The aim of this study was to compare the influence of the number of coronal walls and post-endodontic restorations on the mechanical strength of 165 recently extracted endodontically treated maxillary premolars.Methods: The teeth were divided into 3 control (no post) and 3 test groups according to the number of residual walls. Each test group was divided into subgroups according to the type of post-endodontic restoration (single, oval, and multi-post techniques). Samples were prepared conforming to the assigned subgroup. A universal loading machine applied a load parallel to the longitudinal axis of the teeth, thus simulating physiological occlusion. ANOVA and the Kruskal Wallis test were used for comparisons (P ≤ 0.05), and Tukey's test for multiple comparisons.Results: For intact teeth, significant differences were found among all 3 subgroups, with single post showing the highest values. For 3 residual walls, oval post resulted in significantly lower values than single and multi-post systems. For 2 residual walls, the multi-post technique showed almost twice the resistance of oval post restorations.Conclusion: In oval canals the use of a single or multi-post technique increased post-and-core resistance even in intact teeth, whereas oval fiber posts showed no improvements. Multi-post design improved fracture resistance mostly in maxillary premolars lacking both marginal ridges. [ABSTRACT FROM AUTHOR]

The requirement for an ideal post and core system should consider physical properties such as modulus of elasticity, compressive strength and coefficient of thermal expansion that are close to that of dentin. Additionally, posts should demonstrate high retention, good biocompatibility, esthetics and retrievability. The aim of the survey was to study the level of awareness and current state of knowledge and opinions towards Everstick post as post endodontic restoration amongst the dental students of saveetha dental college. A questionnaire survey was devised to collect information regarding knowledge and awareness about everstick post, and its use as post endodontic restoration. It was distributed among several dental students( undergraduates and post graduates), dental practitioners and Endodontists, through google form (online survey planet). Around 130 responses were received. The results were represented in the form of pie charts and graphs. Chi square test was used to find the association of knowledge, attitude and practice related questions among different fields of practice of respondents. Dental undergraduate students lack theoretical knowledge of everstick posts and they were enthusiastic to learn through CDE programmes and workshops. Everstick post can be an alternative option for extensive damaged crowns. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to comparatively evaluate the fracture resistance of different metallic post and core materials. Materials and Methods: Twenty-four maxillary–central incisors were selected, standardized, and segregated into three groups (GP I–III) (n = 8) based on the type of alloy used for post and core preparation. GP I (gold alloy [Au]), GP II (chrome–cobalt alloy [Co–Cr]), and GP III (titanium alloy [Ti]) were comparatively evaluated for use as post and core materials. The teeth were endodontically treated and tooth preparation for post core was done.Metal post and cores were fabricated using indirect wax pattern and luted. Teeth were mounted on resin bases, fracture testing was done, and type of fractures were analyzed. Results: Mesiodistal type of fracture was the most common among experimental groups with a percentage incidence of 54.20%. The comminuted type of fracture was the next most common with a percentage incidence of 29.2%. The incidence of buccolingual, transverse, and other type of fracture was not common and had a percentage incidence of 29.2%, 4.2%, 8.3% and 4.2% respectively. Group II had the highest fracture resistance with a mean value of 742.89N. Group III and Group I had mean values of 482.33 and 361.1123N. Statistically significant difference between experimental groups (I and II) and (II and III) was observed in load values of root fracture (P < 0.05). Conclusion: On the basis of the protocols used and limitations of this study, among metallic post and core materials tested, GP II had the highest fracture resistance values. Further evaluation of these different post and core systems, new alloy formulations designed specifically for use as post and core materials, and assessment in a clinical setting is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Aim was to evaluate the impact of glass fiber versus titanium endodontic posts on the interproximal bone level around severely damaged endodontically treated teeth. Materials and methods: 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 = <12 months and T1 = 36–72 months 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. Results: The mean observation period was 54 months for glass fiber and 50 months 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 = − 0.03 mm and ∆DBL = − 0.06 mm; titanium group, ∆MBL = − 0.07 mm and ∆DBL = − 0.17 mm; both p > 0.05). Overall, impact of post material on bone loss was almost negligible with a nonsignificant difference between materials of 0.10 mm during the entire study period. Conclusion: The rigidity of endodontic post material has no impact on the level of alveolar bone support of severely damaged endodontically treated teeth. Clinical relevance: 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. [ABSTRACT FROM AUTHOR]

Introduction: 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. Aim: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Objectives: To analyse the key factors of the restoration in the posterior endodontically treated teeth, through a literature review and clinical cases presentation. To focus on the clinical advantages of the adhesive indirect restorations, describing the basic principles for long-term success. Materials and methods: The biomechanical changes due to the root canal therapy and the degree of healthy dental tissue lost because of pathology and iatrogenic factors are the critical points leading the clinician to the restorative treatment planning. The full crown is considered by the literature as the gold standard and is indicated in case of teeth heavily weakened by dental caries, fractures or previous conservative-prosthetic preparations. The improvement of the adhesion and the composite materials, with mechanical properties close to those of dental tissues, offers to the clinician the option of a conservative restoration, able to seal, reinforce and protect the tooth and to delay the execution of a full crown, with the subsequent sacrifice of dental tissue. Although in the presence of small-sized cavity, direct bonded restoration is considered an effective short and medium-term restoration, cuspal coverage with indirect restoration is the treatment of choice in case of mesio-occlusal-distal cavities. Adhesive overlays preserve coronal structure, avoid contamination of the root canal system, reinforce residual dental tissues, guarantee optimal form, function, aesthetics and offer ergonomic and economic undoubted clinical advantages. Results and conclusions: Direct adhesive restorations, indirect bonded restorations and traditional full crown are three therapeutic options for the single posterior endodontically treated teeth. The amount of remaining sound tooth structure is the most significant factor influencing the therapeutic approach. The clinician's operative skill is a determining aspect for long-term success of adhesive inlays.

Introduction: 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. Aim: 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. Material and Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate retrospectively the longevity of endodontically treated teeth restored with direct resin composite without cusp coverage, with or without the insertion of fibre posts. The null hypothesis was that direct restorations with fibre posts perform better than those without fibre posts. Methods: Patients recruited for this study were treated in the Department of Cariology and Operative Dentistry, University of Turin, between 2008 and 2011. In total, 247 patients with 376 root treated posterior teeth, restored with direct resin composite, were recalled for a control visit. Only second-class cavities were considered. Two groups were defined based on the absence (Group A) or presence (Group B) of fibre post. Failures and complications, such as periodontal failure, endodontic failure, tooth extraction, root fracture, post fracture, post debonding, replacement of restoration, crown displacement, and coronal-tooth fracture, were noted. Functional restoration quality was evaluated following the modified USPHS criteria. Data were evaluated statistically with ANOVA. Results: Group A consisted of 128 patients with 178 restorations (88 premolars, 90 molars) with a median follow-up of 34.44 months. Group B consisted of 119 patients with 198 teeth (92 premolars, 106 molars) with a median follow-up of 35.37 months. Direct restorations with fibre posts were statistically significantly more functional (95.12% success) than those without fibre posts (80% success) because of less marginal discolouration, better marginal integrity, and higher restoration integrity. Conclusions: The null hypothesis was accepted because direct post-endodontic restorations with fibre posts performed better than restorations without posts after 3 years of masticatory function. Clinical significance: An evaluation of the longevity of post endodontic direct restoration would seem to enhance the fiber post insertion within a composite restoration to reduce clinical failures. [ABSTRACT FROM AUTHOR]

Aim To evaluate the influence of the luting system on the pull-out bond strength of conventionally and adhesively luted fiber-reinforced composite posts ( FRCPs). Material and methods One hundred extracted bovine teeth ( Di 3) were endodontically treated and randomly assigned to nine test groups and one control group ( n = 10) according to luting system. After preparing the post cavities (8 mm), the custom-made FRCPs were inserted using conventional glass-ionomer cement (Ketac Cem), resin-reinforced glass-ionomer cement ( Meron Plus and Fuji Plus), self-adhesive resin cement ( Rely X Unicem and Bis Cem), self-conditioning adhesive and resin cement [ Multilink Primer + Multilink and Adhe SE + DC Activator + Multi Core Flow, or etch-and-rinse adhesive and resin cement ( Seal Bond Ultima + Core Cem, and Luxa Bond + Luxa Core Z). As a control, custom-made titanium posts were inserted with Ketac Cem. After water storage (37°C, 24 h, dark), the pull-out test was performed, followed by failure mode evaluation. The data were statistically analyzed (α = 0.05) using analysis of variance and the Dunnett T3 post hoc test. Results Luting system type and identity significantly influenced bond strength ( P < 0.001); the bond strengths of all luting systems except Ketac Cem, Meron Plus, and Bis Cem were significantly higher than the control (4.4 ± 1.1 MPa). Rely X Unicem (12.0 ± 3.0 MPa) and LB + LCZ (14.8 ± 2.3 MPa) generated the highest bond strengths. The clinical application was demonstrated by restoring a traumatized tooth with extensive coronal destruction and thin root canal walls, using a FRCP combined with direct composite build-up. Conclusion Luting system selection significantly influenced the bond strength of conventionally and adhesively luted FRCPs to bovine root canal dentin. [ABSTRACT FROM AUTHOR]

To evaluate the influence of coronal restorations on the fracture resistance of endodontically treated teeth, 676 root canal-filled and restored posterior teeth were evaluated after a mean period of 9.7 (±2.8; minimum: 5) years. A total of 86.2% of the endodontically treated and restored teeth survived the mean observation period of 9.7 years without fracture. The overall survival period was 13.6 (± 0.2) years . All teeth with gold partial crowns survived without fractures ( n = 24). Teeth with crowns and adhesively sealed access cavities showed a mean survival period of 15.3 (± 0.4) years, with crown and bridge restorations 14.0 (± 0.3), with individual metal posts 13.9 (± 0.2), with composite fillings 13.4 (± 0.5), with prefabricated metal posts 12.7 (± 0.6), with amalgam fillings 11.8 (± 0.6) and with glass ionomer cements ( GIC) 6.6 (± 0.5) years. Teeth with one or two surfaces restored by amalgam, composite or GIC showed a significantly lower fracture rate than teeth with three and more restored surfaces ( P < 0.05). The mean fracture rate of teeth restored with GIC was significantly higher when compared with all other groups ( P < 0.001). In general, endodontically treated teeth restored with prosthetic restorations demonstrated a significantly lower mean fracture rate than teeth restored with fillings. Cavities with up to three surfaces may well be successfully restored adhesively with composite filling material. [ABSTRACT FROM AUTHOR]

Bitter K, Meyer-Lueckel H, Fotiadis N, Blunck U, Neumann K, Kielbassa AM, Paris S. Influence of endodontic treatment, post insertion, and ceramic restoration on the fracture resistance of maxillary premolars. International Endodontic Journal, 43, 469–477, 2010. Aim To investigate the effects of endodontic treatment, post placement and ceramic restoration type on the fracture resistance of premolars. Methodology One hundred and twenty teeth maxillary premolars were allocated to four groups (A–D; n = 30). In group A, mesio-occlusal-distal-inlays with a buccal and palatal wall of 2 mm (MOD), in group B partial onlays with palatal cusp coverage and in group C total onlays with buccal and palatal cusp coverage were prepared. Group D served as untreated controls. Groups A–C were divided into three subgroups ( n = 10): (i) teeth received solely the described preparations, (ii) teeth were root filled, (iii) teeth were root filled and quartz fibre posts were placed. Teeth were restored using Computer-assisted design/computer-assisted machining-ceramic-restorations and subjected to thermo-mechanical-loading; subsequently, the buccal cusp was loaded until fracture. Results Group D revealed significantly higher fracture resistance [mean (standard deviation)] [738 (272) N] compared to all other groups ( P < 0.05; post hoc test Dunnett). For groups A–C, fracture resistance was significantly affected by the restoration type ( P = 0.043) and endodontic treatment/post placement ( P = 0.039; 2-wayanova). Group A [380 (146) N] showed significantly lower fracture resistance compared to group B [470 (158) N] ( P = 0.048; post hoc test Tukey). Compared to non-endodontically treated teeth [487 (120) N], root filled teeth revealed significantly lower fracture resistance [389 (171) N] ( P = 0.031). Conclusion The restoration of cavities with a remaining wall thickness of 2 mm using ceramic MOD-inlays is inferior with respect to the fracture resistance compared to partial onlay restorations. Root filled teeth without post placement show lower fracture resistance compared to non-endodontically treated teeth. [ABSTRACT FROM AUTHOR]

This paper analyses the mechanical behaviour of a new reinforced anatomical post-systems (RAPS) for endodontic restoration. The composite restorative material (CRM) completely fills the root canal (as do the commonly used cast metal posts) and multiple prefabricated composite posts (PCPs) are employed as reinforcements. Numerical simulations based on 3D linearly elastic finite element models under parafunctional loads were performed in order to investigate the influence of the stiffness of the CRM and of the number of PCPs. Periodontal ligament effects were taken into account using a discretised anisotropic nonlinearly elastic spring system, and the full discrete model was validated by comparing the resulting stress fields with those obtained with conventional restorations (cast gold-alloy post, homogeneous anatomical post and cemented single PCP) and with the natural tooth. Analysis of the results shows that stresses at the cervical/middle region decrease as CRM stiffness increases and, for large and irregular root cavities that apical stress peaks disappear when multiple PCPs are used. Accordingly, from a mechanical point of view, an optimal RAPS will use multiple PCPs when CRM stiffness is equal to or at most twice that of the dentin. This restorative solution minimises stress differences with respect to the natural tooth, mechanical inhomogeneities, stress concentrations on healthy tissues, volumes subject to shrinkage phenomena, fatigue effects and risks of both root fracture and adhesive/cohesive interfacial failure. [ABSTRACT FROM AUTHOR]

For endodontically treated teeth, there are no standardized measures available to define the extent of loss in tooth substance prior to final restoration. In this study, defect size was classified and the applicability of the classification was tested related to the inter- and intra-examiner reliability. For classification, three parameters were investigated: (i) remaining tooth substance in the vertical dimension (level A–D, aspect I), (ii) remaining tooth substance as regarded horizontally (mm; bucco-lingual and mesio-distal, aspect II), and (iii) size of the orifice (mm; aspect III). Four non-calibrated or (pre-trained) examiners were asked to gauge and classify 20 casts of clinically broken down teeth. The measurements were repeated twice every alternative week giving three separate readings. Inter-examiner reliability was determined at weeks 1, 3 and 5. The intra-examiner reliability was compared between readings 1 and 2, 1 and 3, and 2 and 3. As statistical tests, intra-class correlation (ICC) and Cohen's kappa (weighted) were used at a significance level of P < 0·05. Inter- and intra-examiner reliability for ordinal data (aspect I) revealed, with one exception, ‘moderate’ to ‘very good’ evaluations. Inter- and intra-examiner reliability (ICC) of metric data of aspect II and III was primarily ‘excellent’. It may be concluded that the newly developed classification could be applied as an appropriate and reproducible method to define defect extension in endodontically treated teeth. [ABSTRACT FROM AUTHOR]