ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Post Material Affects Stress Distribution, Thus Resistance To Fracture In Endodontically Restored Anterior Teeth
Clinical Question In endodontically treated (non-vital) anterior teeth is a gross fiber post associated with lower incidence of tooth fracture compared to a metallic post?
Clinical Bottom Line According to these studies, glass fiber posts placed in endodontically treated anterior teeth demonstrate a more even distribution of forces than metallic posts, and are thus less likely to result in coronal and root fractures in these teeth. (See Comments on the CAT below)
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) 19553714Silva/2009Extracted central incisorsIn vitro study
Key resultsIn this study, a finite element analysis (FEA) was used to determine the stress distribution on endodontically treated maxillary central incisors that were restored with different prefabricated posts. The teeth were divided into various groups and restored with four different metallic pre-fabricated posts, a glass fiber post, and a control group of sound incisors. Before the study was conducted, the values for the mechanical properties of each of the post and core systems was determined by a review of the literature. Each of the incisors was then subjected to a 2N force on the lingual surface at a 135 degree angle. The stress results were recorded by shear stress and the von Mises criteria. The results of the study showed that there was no significant difference between the stress distribution of the metallic post systems in the radicular region of the incisors. However, there was a higher stress concentration in the coronary region with the metallic (titianium) posts than with the glass fiber posts. It was also determined that the external form of the metallic post did not influence their stress distribution. In conclusion, the glass fiber post was found to be more homogenous in its stress distribution, resulting in fewer fractures than the various metallic systems.
#2) 18538068Abo/200856 Extracted anterior teethIn vitro study
Key resultsIn this study, extracted maxillary anterior teeth were endodontically treated and the teeth were divided into 7 test groups according to the post-adhesive combination used (n = 8 in each group). Core build-ups to restore anatomic form were made from light-cured composite (TPH3). The teeth were mounted at a 135 degree angle to the horizontal and loaded in an Instron machine. The loading was applied to the point of fracture. The fracture loads were recorded, means and standard deviations (SDs) were calculated, and the data was analyzed with analysis of variance (ANOVA) and Tukey's tests. ANOVA revealed significant differences among the groups (p < 0.001). In addition, the mean fracture value for group 7 (everStick post with Xeno-III bonding agent and Panavia-F adhesive) was significantly higher than those of the other groups p < 0.05) except for groups 4 (ParaPost Fiber White post with Clearfil SE Bond bonding agent and Panavia-F adhesive) and 6 (everStick post with Clearfil SE Bond bonding agent and Panavia-F adhesive). This study found that the use of a novel glass fibre post (the everStick post) was associated with the highest mean fracture force for maxillary anterior teeth, regardless of the bonding agent used, whereas the stainless steel post was associated with the lowest mean fracture force. This means that glass fiber post had a significantly higher fracture resistance than the metallic posts.
Evidence Search Search ((“Tooth, Non-vital\"[Mesh] AND \"Incisor\"[Mesh]) AND (\"Tooth Fractures\"[Mesh] OR \"Tooth Fractures/prevention and control\"[Mesh]) Limits: Randomized Control Trials
Comments on
The Evidence
These studies were randomized control trials. The trial groups appeared to be treated the same, and the group completion rate was not mentioned but assumed to be 100%, considering that these were in vitro studies. There did not seem to be any ulterior motives or hidden agendas in these studies.
Applicability This study can be clinically applied to patients needing endodontic treatment and restoration in anterior teeth. These studies help confirm the superiority of fiber posts compared to metal posts when restoring endodontically treated anterior teeth.
Specialty/Discipline (Endodontics) (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Post and Core
ID# 599
Date of submission: 04/02/2010spacer
E-mail longoriaaa@livemail.uthscsa.edu
Author Aissa Longoria
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mark Littlestar, DDS
Faculty mentor/Co-author e-mail littlestarm@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)
post a comment
by Abdulmohsen Alqasir & Talal T. Al-Rasheed (Riyadh) on 06/25/2014
The clinical question is somewhat misleading (help prevent fracture resistance). We searched PubMed in June 2014 and found a more recent article PubMed: 24748301, which supports the results of this CAT.
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