ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Restoration of Endodontically Treated, Single-Rooted Fracture Resistance is Similar with Cast and Direct Posts and Cores for Endodontically Treated Teeth
Clinical Question In an endodontically treated tooth does placement of a cast post show more success against fracture compared to a prefabricated post?
Clinical Bottom Line Based on in vitro and clinical studies, there is no difference in fracture rate of cast and direct posts and cores.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12011847Heydecke/2002in vitro studySystemic Review
Key resultsThere is no significant difference in survival rate of cast and direct posts and cores. “The survival for cast posts and cores in 2 studies ranged from 87.2% to 88.1% and in a third study reached 86.4% for direct cores after 72 months.”
Evidence Search National Library of Medicine (PubMed) was searched using the following search terms: endodontically treated teeth, cast post and prefabricated post
Comments on
The Evidence
An electronic data base was used as a research engine for this study on restoration of endodontically treated teeth. The search yielded a total of 1773 references. 10 in vitro and 6 in vivo studies were critically reviewed. Based on the in vitro studies there is no difference in fracture rate between cast and direct posts and cores. Also based on meta-analysis of the data there is no difference in fracture behavior associated with the prefabricated and cast post and core. It was not possible to perform a survival analysis for the in vivo studies.
Applicability Even though an overall survival analysis was not possible for the in vivo studies, the authors concluded that there was no difference in survival behavior of cast and direct posts and cores.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords endodontically treated teeth, cast post, prefabricated post
ID# 2073
Date of submission: 07/07/2011spacer
E-mail ghanizadeh@uthscsa.edu
Author Hoda Ghanizadeh
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author John Gildersleeve, DDS
Faculty mentor/Co-author e-mail GILDERSLEEV@UTHSCSA.EDU
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Daniel Chitty (San Antonio, TX) on 11/28/2017
A search was conducted November 2017, and two applicable and more recent studies were found. One study, a randomized control trial (PMID: 24836285) by Pereira, published in 2014, found that "prefabricated posts […] showed significantly lower characteristic strength and probability of survival than cast post and core." This result is a significant departure from the evidence reviewed in the CAT. However, considering that this is a single study focusing on 40 fatigued endodontically-treated teeth, while the CAT critically reviewed a systematic review of 16 studies (including 6 in vivo studies), the new evidence does not have a significant impact on the original answer to the clinical question. Another study, a systematic review (PMID: 23663088) by Ploumaki, published in 2013, supports the findings of the original CAT. This review reported the success rates for cast posts and prefabricated posts at 93% and 94% respectively.
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