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Clinical testing
As the inventors and early adopters of this low-modulus reconstruction / mono-block concept began to see remarkable differences in the behavior patterns IN VITRO, it became time to confirm these trends clinically.
Clinical placement and observation began in France in 1989, by the inventor dentists, followed by some European dental schools in the early 1990's.
The first published clinical trial, which included only the original Carbon fiber ComposiPost (C-POST), was published in 1998 (Fredricksson, et al). It included anterior and posterior teeth over a 2-3 year span.
There are some prospective and retrospective clinical papers published which directly compare the results of early generations of fiber posts to the traditional custom cast posts, in the 4-year service range. The disparity noted in these studies alone have been the impetus for change in the traditional curricula in many dental schools.
As of mid 2007, authoritative academic researchers are publishing summaries of their clinical observations at 7 – 11 years' service; including all classifications of teeth, endodontic treatments and restorative treatments, and which include several successive generations of RTD fiber posts.
In vitro testing has demonstrated that successive generations of fiber posts coming from RTD (Composipost, Aestheti-Post, Aestheti-Plus, Light-Post, D. T. Light-Post) perform equal to their predecessors in function (mechanical properties). This is because the composition ratios, manufacturing process and quality parameters are the same. Likewise, the results from the 2-year published clinical trials on the newest DT Light-Posts echo the same success rates (or better) than its less esthetic, less radiopaque predecessors.
There are some published clinical evaluations of other (NON-RTD) fiber posts, but none in excess of 2-3 year's duration. However, because of the sometimes dramatic differences in composition, mechanical properties, and shape, between RTD posts and others', one should not conclude that two year clinical results with non-RTD posts will extrapolate to clinical results rivaling those of RTD posts.
Objectives: To evaluate whether the exposure to the oral environment and occlusal wear during function affects the morphological integrity of fiber posts underlying a luted crown or a direct composite restoration.
Methods: Two groups of endodontically treated teeth restored with DT Light- Posts (RTD, St. Egreve, France) were investigated. Group 1 included ten crowned teeth in which the abutment had the post head exposed on the surface. Group 2 included ten teeth directly restored with resin composite and presenting with the post head exposed on the occlusal surface of the restoration. For baseline evaluation, polyether impressions (Permadyne, 3M ESPE) were taken of the abutments before crown luting in Group 1, and of the restorations occlusal surfaces immediately after polishing in Group 2.
Results: After a 5-year period of clinical service, polyether impressions were taken again for each experimental tooth. All the impressions were developed with epoxy resin and observed under a scanning electron microscope (Jeol, Tokyo, Japan), in order to assess whether the post surface underwent structural changes due to water uptake (Groups 1 and 2) and/or occlusal wear (Group 2) during the clinical function. Results: In neither group microscopic signs of post surface degradation due to water uptake were seen. In Group 2 wear signs were visible on the exposed post surface, as well as on the surface of the direct composite.
Conclusion: Over a 5-year period, in case the fiber post surface is exposed on the top of the abutment, the seal provided by the crown effectively protects the fiber post against water uptake. When the post surface is exposed in a direct resin restoration, it does not show evident morphological changes related to water degradation, although it exhibits a loss of structure due to occlusal wear.
Goracci, C. ,Cagidiaco, M., Cagidiaco, E.,Vichi, A., Grandini, S., Ferrari, M.. Effects of oral environment and occlusal wear on FRC-posts integrity. J Dent Res. Vol 86 (Spec. Iss. A) Abstract #0131, 2007 (www.dentalresearch.org)
Purpose: This study evaluated the 2-year outcome of post-and-core restorative procedures in endodontically treated teeth. The effect of baseline factors (tooth type, number of residual coronal walls, and type of definitive restoration) on restoration failure was assessed.
Methods: The consecutive sample design included 150 patients. A total of 162 teeth (57 anterior and 105 posterior) were restored. Sixty-nine teeth had 3 or 4 residual coronal walls, while 93 teeth had 2 or fewer walls. Crowns and direct resin composite restorations were placed in 121 and 41 teeth, respectively. After 23 to 25 months, all patients were evaluated. Logistic regression was used to identify the joint effect of variables recorded at baseline (P<.05).
Results: The only failure modes observed were post debonding (4.3%, 2 in anterior teeth and 5 in posterior teeth) and endodontic failure (3.0%, 2 in anterior teeth and 3 in posterior teeth). All post debondings occurred in teeth with 2 or fewer coronal walls that were crown covered. All endodontic failures occurred in crown-covered teeth (1 failure in a tooth with 3 walls and the remaining 4 failures in teeth with 2 or fewer walls). Logistic regression found no statistical significance for any of the variables recorded at baseline.
Conclusion: Restorations placed with the use of a fiber post (DT Light-Post, RTD, France) and core resulted in 4.3% post debondings and 3.0% endodontic failures after 2 years of clinical service.
Abstract/conclusions: The restoration of root canal treated teeth – because of the significant loss of tooth structure- is often achieved with post and core. However, posts may generate stresses, which lead to vertical root fracture and the loss of the tooth. Since post design, materials used and post space preparation has significant influence on vertical fracture prevalence, broad investigation is in progress to find the optimal procedure. During the last decade, new prefabricated passive posts were introduced for postendodontic restorations. In order to collect information, clinical trials have been performed on the reconstruction of root canal treated teeth using Carbon fiber posts (C-POST/ COMPOSIPOST). Adhesive technique was applied to cement post in the root canal and for composite core reconstruction. The physical properties of the Carbon fiber posts and the composite are very close to those of the dentine. Post application is simple, does not require special skill and, for the patient, means minimum hazard. The position of the post was controlled by radiography. During the 24 months observation period, no failure was registered in patients treated (N=55). Hence, we attribute our good results to the homogenous reconstruction of the teeth. This procedure seems to be a good alternative to traditional cast metal dowel/cores or metal prefabricated posts.
Ferrari, M., Cagidiaco, M., Vichi, A., Goracci, C. , Vichi, A., Mason, P., Radovic, I, Tay, F. Long term retrospective study of the clinical performance of fiber posts. Am J Dent 2007;20, Sept. 2007
ABSTRACT: Purpose: To retrospectively evaluate the long-term clinical performance of three types of fiber posts after a service period of 7-11 years.
Methods: 985 posts were included in the study: 615 Composiposts, 160 Æstethic Posts and 210 Æsthetic Plus Posts were placed into endodontically treated teeth. Four combinations of dentin adhesives/luting materials were used. Endodontic and prosthodontic results were recorded.
Results: A 7-11% failure rate was recorded for the three types of posts. 79 failures in total were noted; 39 due to endodontic reasons, 1 root fracture, 1 fiber post fracture, 17 crown dislodgements and 21 due to post debonding. The mechanical failures were always related to the lack of coronal tooth structure. The results indicated that fiber posts in combination with bonding/luting materials may be used routinely for restoring endodontically treated teeth. Mechanical failure of restored teeth with fiber posts can be related to the amount of residual coronal structure.
CLINICAL SIGNIFICANCE: The use of fiber posts in combination with adhesive restorative materials can provide a long term clinical success in endodontically treated teeth.
Purpose: This retrospective study evaluated treatment outcome of cast post and core and Composipost systems after 4 yrs of clinical service.
Methods: 200 patients were included in this study. They were divided into two groups of 100 endodontically treated teeth restored with a post. Group 1: Composipost systems were luted into root canal following the manufacturer's instructions. Group 2: Cast post and cores were cemented into root canal preparations with a traditional technique. The patients were recalled after 6 months, 1, 2 and 4 yrs and clinical and radiographic examinations were completed. Endodontic and prosthodontic results were recorded.
Results: Group 1: 95% of the teeth restored with Composiposts showed clinical success; 3 of these samples were excluded for noncompliance and 2% showed endodontic failure. Group 2: Clinical success was found with 84% of teeth restored with cast post and core. 2% of these samples were excluded for noncompliance, 9% showed root fracture, 2% dislodgment of crown and 3% endodontic failure. Statistical evaluation showed significant differences between Groups 1 and 2 (P<0.001). The results of this retrospective study indicated that the Composipost system was superior to the conventional cast post and core systems after 4 years of clinical service.
Purpose: To evaluate the clinical performance of C-Posts, Aestheti- Posts and Aestheti-Plus Posts after a period of clinical service ranging from 1-6 yrs.
Methods: 1,304 posts were included in the study: 840 Composiposts, 215 Aestheti-Posts and 249 Aestheti-Plus posts were placed into endodontically treated teeth. Four combinations of bonding/luting materials were used. The patients were recalled every 6 months and clinical and radiographic examinations were completed. Endodontic and prosthodontic results were recorded. Actuarial Life Table statistical analysis and Mantel-Haenszel comparison of survival curve have been performed at 95% level of confidence.
Results: The 3.2% failure rate was due to two reasons: 25 posts debonded during removal of temporary restorations, and 16 teeth showed periapical lesions at the radiographic examination. No statistically significant differences were found among the four groups. The results of this retrospective study indicate that fiber posts in combination with bonding / luting materials can be routinely used.
Ferrari, M, Cagidiaco, M. ,Vichi, A., Grandini, S., and Goracci, C., Post placement and residual coronal structure affect root-treated premolars' survival J Dent Res. Vol 86 (Spec. Iss. A) Abstract #1385, 2007 (www.dentalresearch.org)
Objective: to assess whether the amount of residual coronal dentin and the placement of a fiber post (D T Light-Post; RTD, St Egrève, France) or EverStick Post (Stick Tech, Turku, Finland) have a significant influence on the three-year survival of restored pulpless premolars.
Methods: A sample of 345 patients provided 6 cohorts of 60 premolars in need of endodontic treatment. Cohorts were defined based on the amount of dentin left at the coronal level after endodontic treatment and before abutment build-up. Within each cohort teeth were randomly divided into three Subgroups (n=20). In Subgroup A no endocanalar retention was provided for the coronal restoration. In Subgroups B and C a fiber post (RTD) and Stick Tech fibers (ST) respectively were placed inside the root canal. All the teeth were covered with porcelain fused to metal crowns.
Results: Data were not affected by any loss to follow-up. The overall 36-month survival rate of crowned endodontically treated premolars was 76.70%. The lowest survival rate was recorded for teeth restored without any endocanalar retention (62.5%). Teeth restored with RTD had a survival rate higher (90.9%) than those restored with ST (76.7%). The Cox regression analysis showed that the presence of an endocanalar retention was a significant factor for survival (p<0.05). The decrease in failure risk was higher in teeth restored with RTD than when using ST. Teeth retaining one, two, or three coronal walls had a significantly lower failure risk than teeth deprived even of the ferrule effect. Similar failure risks existed for teeth missing all the coronal walls regardless of the presence or absence of a ferrule effect. Interaction terms were not significant (p>0.05).
Conclusion: Post placement and the amount of residual coronal dentin affect the 3-year survival of endodontically treated premolars.
Ferrari, M., Cagidaiaco, MC., Grandini, S., DeSantis, M., Coracci, C. Post placement affects survival of endodontically treated premolars. J Dent Res 86(8)729-734, 2007.
Abstract: Clinical evidence is lacking regarding the influence of the amount of residual coronal dentin and of post placement on the failure risk of endodontically compromised teeth. The aim of theis prospective clinical trial was to assess whether thse factors significantly affect the two year survival of restored pulpless premolars. A sample of 210 individuals provided 6 experimental groups of 40 premolars in need of endodontic treatment. Groups were defined based on the amount of dentin left at the coronal level. Within each group, in half of the teeth selected at random, a fiber`post was inserted inside the root canal, whereas in the remaining half of the premolars, no post was placed. All teeth were coveredwith a crown. The Cox regression analysis revealed that post placement resulted in a significant reduction of failure risk (p< 0.001). Failure risk was increased for teeth under the "no ferrule" (p=0.001) and "ferrule effect" (p= 0.004).
Statement of problem: The Composipost dowel is made of stretched, aligned carbon fibers embedded in an epoxy-resin matrix. It is widely used in Europe and Canada for the restoration of endodontically treated teeth and was introduced in the United States 2 years ago as the C-Post dowel.
Purpose: This retrospective study evaluated treatment outcome of the Composipost system after 2 to 3 years.
Methods: A total of 236 patients treated during a 1-year period by seven Swedish dental practitioners were included. Of those, 146 patients consented and data were collected from the dental records of the remaining patients. Thus, the material comprised 236 teeth restored with carbon fiber-reinforced epoxy resin post, 130 maxillary and 106 mandibular teeth, with a mean restoration time of 32 months (range 27 to 41). Periodontal conditions, radiographic signs, and prosthodontic results were recorded.
Results: Five teeth (2%) had been extracted for reasons unrelated to the Composipost system. Periodontal conditions such as plaque accumulation, gingival health, bleeding on probing, and pocket depth around the teeth with Composipost dowels were similar to the control teeth. No dislodgement or root or post fractures were observed clinically or on radiographs. Radiographic examination of bond height measured from the apex to the bone margin mesially and distally showed differences on the mesial side but not on the distal surface (p < 0.05) between the Composipost-treated teeth and the controls.
Conclusions: Promising results after 2 to 3 years of clinical service indicate that this system can be a viable alternative to conventional post-and-core systems.
Abstract: A prospective study was started in 1995 to evaluate the success of carbon fiber reinforced epoxy resin (Composipost) posts used to restore endodontically treated teeth. All the teeth in the study had lost more than 50% of their coronal structure.
Methods: Fifty-nine carbon fiber Composiposts cemented with C & B Metabond and built up with Core Paste cores were placed into the teeth of 47 patients. Each tooth received a full-coverage restoration (porcelain fused to metal crown) and was followed for 6.7-45.4 months (average = 28.0 months, standard deviation = 10.7).
Results: Results for 52 teeth in 42 patients were analyzed. There were no fractures. The overall failure rate was 7.7% and the cumulative survival rate was 89.6% at the end of the follow-up period. The only statistically significant finding (p=0.04) was that posts in lower premolars were at higher risk of failure.
Conclusion: Composipost posts are among the most predictable systems available today. Composipost posts in the upper anterior teeth are associated with a higher success rate and longer life than those placed in premolars, especially lower premolars. This study contributes to the growing body of evidence that supports the use of Composipost posts in the restoration of endodontically treated teeth.
Purpose: Restoration of root-treated teeth is routinely performed in clinical practice with a choice of therapeutic options, considering many factors to provide optimal mechanical properties, esthetics, and longevity. The aim of the present work was to present a preliminary clinical report on the use of fiber posts and direct resin composites for restoring root-treated teeth.
Methods: Thirty-eight anterior and 62 posterior endodontically treated teeth were selected from 3 private prosthodontic offices. The protocol used included endodontic treatment, with translucent fiber posts (DT Light-Post) bonded to the post-space using a ‘1-bottle' adhesive (One-Step, Bisco) and a dual-cure resin cement (DuoLink, Bisco). Direct resin restorations were performed using a micro-hybrid resin composite (Gradia Direct, GC) and a layering technique. Both opaque dentin and enamel and translucent enamel shades were used.
Results: Patients were recalled after 6, 12, 24, and 30 months, and the restorations assessed according to predetermined clinical and radiographic criteria. These clinician-mediated evaluation methods confirmed the good clinical performance of the restorations.
Conclusion: Restoration of endodontically treated teeth with fiber posts and direct resin composites is a treatment option, that in the short term conserves remaining tooth structure and results in good patient compliance.
Abstract: In the attempt to achieve the best-performing post and core restoration, many post systems have been studied. In the recent past, the aesthetic fiber posts, in combination with resin luting cement, have been proposed to provide a reliable rehabilitation for the endodontically treated tooth. The new translucent fiber posts show interesting mechanical properties (comparable to the dentin) and aesthetic characteristics that enhance a final rehabilitation with an all-ceramic crown…with satisfying results.
Objectives: The purpose of this study was to evaluate the clinical behavior of 84 endodontically treated teeth treated with translucent quartz fiber posts. Thirty four teeth recieved a LIGHT-POST (RTD/Bisco) and 50 teeth received the Endo LIGHT-POST (RTD, St. Egreve, France). To perform the cementation, Bisco ONE-STEP and dual – cure DUO-LINK (Bisco) were utilized. The luting cement was polymerized through the translucency of the post.
Methods: All of the core restorations were performed using CORE-FLO (Bisco) or BIS-CORE (Bisco) composite resin and finalized with an all-ceramic crown. In accordance with the international literature, data, useful for the longitudinal evaluations, were recorded on diagrams. The survival rate of the post and core was valuated after 2 weeks, 1, 3, 6, 12 and 20 months. Post displacement or detachment, post fracture, restoration fracture and root fracture were investigated.
Results: No failures took place up to the present day.
Conclusions: According to these results, and within the limitations of this study, it is possible to assume that the clinical performance of these translucent fiber posts is successful. Further data will be needed for long-term clinical evaluations of the outcome.
Purpose: This study prospectively evaluated the clinical performance of three types of translucent posts over a follow-up period of between 2 and 3 years.
Methods: Selected were 225 patients with one premolar in need of endodontic treatment, followed by restoration with a fiber post and porcelain crown. The sample was randomly divided into three groups of 75 patients each. The same type of post was used in all patients within the group: Group 1=Aestheti-Plus posts (RTD), Group 2= D. T. Light-Post (RTD), and Group 3= FRC Postec (Vivadent / Ivoclar). For bonding the posts, a light-cure adhesive (One-Step; Bisco Dental) and a dual-curing resin cement (Duo-Link; Bisco Dental) were applied in Groups 1 and 2, whereas self-curing materials ExciteDSC adhesive (Vivadent/ Ivoclar) and MultiLink resin cement (Vivadent / Ivoclar) were used with Group 3. After 6, 12 and 24 months, patients were recalled, and a clinical and radiographic examination was performed. For some patients, 30-month follow-up data were also collected.
Results: Debonding of the post occurred in eight cases (3.5%); in another six cases, a recurrence of the periapical lesion was reported.
Conclusion: The statistical analysis did not reveal any significant difference in the survival rate of the tested posts, suggesting that all are equally and sufficiently reliable for clinical use.
Objectives: The aim of this study is to provide prospective clinical data for the survival of postendodontic reconstructions of teeth with varying degrees of hard tissue loss using tapered or parallel-sided post shapes.
Methods: Eighty-three patients got 105 glass fiber reinforced posts of tapered (Luscent Anchors, Dentatus, Sweden) and parallel-sided, serrated (FiberKor, Jeneric Pentron, USA) post shape. A dual curing hybrid composite Compolute (3M ESPE, Germany) was used as luting material, EBS-Multi (3M ESPE) as adhesive system and Clearfil Core (Kuraray, Japan) for core built-up. The restorations were followed for a minimum of 24 months. The statistical analysis was performed on a random sub-sample of one restoration per subject. The Fisher exact test was used to compare frequencies of failures after 12 and 24 month. A Kaplan-Meier-analysis was used to analyse time-to-failure in both groups. Differences of survival time between post types were tested with the log-rank test.
Result: 3.8% of the restorations failed after 12 month, 12.8% after 24 month, respectively. The main failure type observed was post fractures. All but one failed teeth could be restored. There was no difference in failure frequency between post types after 12 or 24 months. The log-rank test showed no differences in survival between the two types of post (p=0.37).
Conclusion: Parallel-sided and tapered glass fiber posts result after 2 years of clinical service in an equal rate of survival.
Purpose: The aim of this prospective randomized controlled trial was to evaluate the influence of clinical baseline characteristics on the survival of 2 post systems.
Methods: One hundred patients needing a post were included. Half the patients received a glass fiber-reinforced post (FRP: ER DentinPost, Komet), and the other half received metal screw posts (MSP: BKS post, Komet). The posts were assigned randomly. In addition to demographic data, the following parameters were recorded: type of tooth (incisor/canine versus molar/premolar), length of the post in relation to root length (percentage), extent of coronal tooth destruction (percentage), ferrule height (in millimeters), type of restoration (fixed or removable partial denture), and presence of antagonistic contacts (yes/no). After at least 1 year (mean: 13.84 months), the patients were recalled. Statistical analysis was performed using the log-rank test and Cox regression analysis.
Results: The survival rate of FRPs was 93.5%. In the MSP group, the survival rate was significantly lower (75.6%; log-rank test, P = .049). Additionally, the metal posts were associated with more unfavorable complications, for example, root fracture. The type of the tooth and the degree of coronal tooth destruction influenced the survival of MSPs, whereas no influence of these variables could be seen for FRPs.
Conclusion: FRPs are superior to MSPs with respect to short-term clinical performance. Especially for MSPs, clinical survival depends on several variables.
The usage of the aesthetic fiber posts is progressively growing for their promising clinical performances and their good aesthetic characteristics.
Objectives: The aim of this 30 months in vivo study is to evaluate the clinical success-rate of 180 endodontically treated teeth, restored by the usage of “white” quartz fiber post and finalized with the metal-ceramic crowns and all–ceramic crowns.
Methods: all the teeth were endodontically treated according to the recent techniques. In accordance with the international literature, to achieve clinical information, parameters were recorded in diagrams. Posts used were ÆSTHETI-PLUS (RDT, St. Egréve, France) in combination with All Bond 2 adhesive resin (Bisco, Schaumburg, IL, USA) and C&B Resin Cement (Bisco, Schaumburg, IL, USA), the build up of the core was performed with the composite material Core-Flo (Bisco, Schaumburg, IL, USA), or Bis-Core (Bisco, Schaumburg, IL, USA). The post and core restorations were evaluated after 2 weeks, 1, 3, 6, 12, 20 (Malferrari et al., IADR abstr #11; Rome 2001) and 30 months, recording the surviving rate.
Results: three failures were observed, one was a cohesive fracture that occurred after two weeks, involving a margin of the composite restoration and two were adhesive fractures, that occurred after a a couple of months, both located at the interface cement and dentinal walls of the canal. As all the failures occurred during removing the temporary it was possible to replace the restorations, that are still in place up to the present day. The 3 failures that occurred during this period do not show any relevance according to the statistical analysis with the Chi Square test (p=0.246).
Conclusion: according to these results, and considering the limits of this study, the quartz posts, within a 30 months period of rehabilitation of endodontically treated teeth, clinically performed with success.
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