Medical

Communication

Biosci. Biotech. Res. Comm. 10(2): 19-24 (2017)

Reconstructing root treated teeth using post

and core – A Systematic Review

O Hedaiat Moradpoor

, Sahar Raissi

* and Erfan Bardideh

Assistant Professor, Prosthodontics Department- Faculty of Dentistry Kermanshah University of Medical

Sciences-Iran

Assistant professor, Prosthodontics department- Faculty of Dentistry Kermanshah University of Medical

Sciences-Iran

Prosthodontics Department- Faculty of Dentistry Kermanshah University of Medical Sciences-Iran

ABSTRACT

Post and core is the main treatment method for reconstructing for endodontically treated teeth. There are differ-

ent reasons for clinical failure of post and cores; such as losing retention, post fracture, root fracture and failure

from periodontal, endodontical complications and dental caries. Purpose of this study was to evaluate and compare

clinical failures in different post and core systems using Network Meta-Analysis.Search strategy was used to search

Central,MEDLINE,Scopus and EMBASE data bases and also IADR conference proceedings from the beginning till

March of 2016 and then after matching studies with inclusion and exclusion criteria. 6 randomized clinical trials

and 4 cohort studies was chosen and then evaluated using Network Meta-Analysis. According to randomized clinical

trials, cast metal posts had the lowest failures in every failure aspect (losing retention, post fracture, root fracture

and failure from periodontal, endodontical complications and dental caries) (OR<1). According to cohort studies,

prefabricated non-metal posts had the lowest clinical failures in every aspect (OR<1). According to sum total of stud-

ies, prefabricated non-metal posts had the lowest root fractures and also lowest sum of failures but cast metal posts

had the lowest post fractures (OR<1).The failures from periodontal, endodontical complications and dental caries

and losing of retention is the same (OR=1). In every single study the prefabricated metal posts had the most clinical

failures of all the post types(OR>1).According to randomized trials, cast metal posts and according to cohort studies,

prefabricated non-metal posts are the best treatment options and according to every study prefabricated metal posts

are the worst treatment options in regards to clinical failure.

KEY WORDS: POST-CORE; META-ANALYSIS; ROOT CANAL TREATED TEETH; CLINICAL FAILURE

ARTICLE INFORMATION:

*Corresponding Author:

Received 1

April, 2017

Accepted after revision 30

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

20 RECONSTRUCTING ROOT TREATED TEETH USING POST AND CORE – A SYSTEMATIC REVIEW BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Moradpoor, Raissi and Bardideh

INTRODUCTION

Reconstructing root treated teeth is one of the biggest

issues in dentistry. Compared to vital teeth, side effect of

reconstructing dentures of root treated teeth was higher

in the restoration and mostly led to tooth loss. Endodon-

tic treatments are primarily done for the crowns hav-

ing restoration failure or crown failure because of rot

(Abo-Rass 1992). When a large amount of crown is lost

because of damage, it is impossible to suf cient anchor-

age can be achieved by the dentin (Heydecke 2002)

Therefore, in cases where the loss of the crown is great,

the “core “ is needed for the  nal restoration and post is

used for its Anchorage (Bolla 1999) and (Ferrari 2002)

and (Belle amme 2017) .

For more than 250 years, clinicians have searched

on the use of in-the- root post to obtain stuck. (Smith

1998). Post and core have a long history of clinical suc-

cess. For teeth with moderate to severe destruction, they

are pretty good, (Terry 2010). Cast post is appropriate

especially for small teeth, when posts should be pro-

vided many teeth at the same time, and when the angle

of core should be different with post (prefabricated post

should not be bend, (Shen 2013).

Also: about 40 percent of dentists are expressed

on a questionnaire that they use normal prefabricated

posts, and metal parallel posts are widely used (Morgano

1994). The use of prefabricated post and direct core s is

the selected method for reconstruction of Muller with

highly destroyed buildings (Morgano 1993). Prefabri-

cated method has a simpler placement method, less chair

time, low cost and the ability to have immediate recon-

struction of teeth (Zalkind 2000). Due to their cylindrical

shape, they are applicable for being used in channels

with circular cross-section (maxillary central incisors)

and are less applicable in the channels with Low mesi-

odistally width and high bucco lingually (Choudhary

2014) and (Soundar 2014) and (Borths 2017) and (Right-

mire 2017).

Fiber Posts history dates back to 1989, the posts of

carbon  ber composite started to be used for clinical use

(Duret 1990). Raw  ber Posts used  ber-graf ti carbon

because of their mechanical properties (such as stiffness

and high tensile strength, low toxicity and electrical

conductivity) (Singh 2015). Zirconia Post was introduced

 rst by Meyenberg claiming that the torsional rigidity

(900-1200 MPa) of the posts is comparable with gold or

titanium castings and the dimensions of the posts can be

in the same size as of gold and casts posts (Meyenberg

1995). Zirconia combined with yttrium was used due

to the chemical stability and high mechanical strength,

high toughness and Yang factor such as an stainless

alloy of steel. Initial resistance and high toughness frac-

ture of zirconia combined with yttrium is due to the phe-

nomenon of transformation toughness (Petercsak 2014).

The following factors affect the choice of posts:

Root length 2. Dental Anatomy 3. post width 4.type of

canal and post compliance 5. Dentin textures 6.location

of tooth in the arch 7.stress 8 Torsional forces 9. Hydro-

static force role 10. Post design 11.compliance of materi-

als together 12. bonding ability 13.core stuck 14.recov-

ery capability 15.beauty (Fernandes 2003). Among the

factors affecting the result of the reconstruction, tooth

type and force on it because of its location in the bend,

proximal contacts and  nal prosthesis (Crown, FPD,

RPD) can be noted. Also, the existence of coronal tooth

structure (called a ferrule effect; ivory collar height of 2

mm) is known as the main feature for the success of the

reconstruction by post and core (Dua 2016)

MATERIALS AND METHODS

The present study is a systematic review. The population

of study is the studies related to databases of Cochrane

Central Register of Controlled Trials (CENTRAL) ‘MED-

LINE’ Scopus ‘EMBASE. In addition, the list of references

and the found studies, and a summary of IADR confer-

ences are from the beginning to the march 2016. Sam-

pling was evaluated by all articles that match survey

strategy , then, articles that met inclusion criteria were

enrolled. Conduction of this systematic review was based

on systematic review guidance of PRISMA . so that: In

order to  nd the studies related to the inclusion crite-

ria, the samples were found according to survey strategy

in databases of Cochrane Central Register of Controlled

Trials (CENTRAL) ‘MEDLINE’ Scopus and EMBASE.

Translation of Non-English references were also used.

The reviewed studies are clinical trial, retrospective and

futuristic Survey strategy is as the following:

Tooth nonvital OR endodontically treated tooth OR

pulpless OR pulp disease OR root  ll teeth OR root  lled

tooth) and (post and core OR post and core system OR

post and core technique OR  ber post OR  ber core OR

metal post OR cast metal OR cerapost OR zirconia post

OR milled zirconia post and core OR  ber-reinforced

post OR carbon- ber post OR carbon-quartz  ber post

OR ceramic post) data obtained by QCochrane test as

well as the I2 were set to ensure homogenity .then, by

L’Abbéplot chart, both the Fixed-Effects and Random-

Effects cases were evaluated, so that if data is heteroge-

neous, Random-Effects method will be used for their the

meta-analysis interpretation.

NetworkMeta-Analysis test was separately done for

the “loss of stuck-cohort post-cohort, fracture, root-

cohort Fracture, etc. (endodontic failure, caries and peri-

odontics) cohort - mixture (all failures) -cohort” / “los-

ing stuck- RCT, post-RCT Fracture, root-RCT Fracture,

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS RECONSTRUCTING ROOT TREATED TEETH USING POST AND CORE – A SYSTEMATIC REVIEW 21

Moradpoor, Raissi and Bardideh

etc. (endodontic failure, caries and periodontics) – RCT,

mixed RCT (all failures) as well as” the loss of stuck-

studies (RCT + Cohort ), Fracture post-studies (RCT +

Cohort), Fracture root-studies (RCT + Cohort), etc. (endo-

dontic failure, caries and periodontics) - studies (RCT

+ Cohort), combined (all failures) - Total studies (RCT

+ Cohort) “ by WINBUGS algorithm for both default

Fixed-Effect and Random-Effect with CI = 95% . Moreo-

ver, results were obtained in the form of OR (Odds Ratio)

and SUCRA number which was used to draw ForrestPlot

and LeagueTable diagrams.

RESULTS AND DISCUSSION

In the case of treatment failure due to loss of stuck in

cohort studies, the amount of the loss in non-metallic

prefabricated posts ( Glass  ber) was Less than metal

prefabricated OR(95% Cr.I.)=0.25 (0.01 – 1.75) and also

less than metal cast (Cast Metal) OR(95% Cr.I.)=0.35

(0.03 – 2.05). In addition, the amount of loss of stuck

cast metal posts (CM) is less than Prefabricated metal

posts (PM) (PM) OR(95% Cr.I.)=0.72 (0.34 – 1.76).In the

case of treatment failure due to loss of stuck in RCT stud-

ies, the amount of the loss in non-metallic prefabricated

posts ( Glass  ber) was Less than metal prefabricated

(PM) OR(95% Cr.I.)=0.27 (0.04 – 1.01), but loss of stuck

in metallic cast posts is less than that of non-metal pre-

fabricated (GF) OR(95% Cr.I.)=0.84 (0.37 – 1.85) and less

than that of metal prefabricated (PM) OR(95% Cr.I.)=0.25

(0.02 – 1.14

In the case of treatment failure due to loss of stuck

in (RCT+ cohort) studies, the amount of the loss in non-

metallic prefabricated posts ( Glass  ber) was Less than

metal prefabricated (PM) OR(95% Cr.I.)=0.59 (0.25 –

1.56), but it was equal with cast metal (CM) OR(95%

Cr.I.)=1.00 (0.56 – 2.04). In addition, loss of stuck in in

cast metal posts is less than that of prefabricated metal

posts (PM) OR(95% Cr.I.)=0.62 (0.26 – 1.33)

In the case of treatment failure due post Fracture in

cohort studies, the amount of post Fracture in prefab-

ricated non-metallic (GF) posts was less than prefab-

ricated metal (PM) OR (95% Cr.I.) = 0.31 (0.06 - 1.04).

In addition, the amount of fracture of metal cast post

(CM) is more than that of non-metal prefabricated

(GF) OR(95% Cr.I.)=1.58 (0.05 – 13.15). Moreover, the

amount of post fracture in cast metal posts is less than

metal prefabricated posts (PM) OR(95% Cr.I.)=0.21

(0.02 – 8.10).

In the case of treatment failure due post Fracture in

RCT studies, the amount of post Fracture in cast metal

posts is less than prefabricated metal (PM) OR(95%

Cr.I.)=0.36 (0.12 – 0.93) and also less than non-metal

prefabricated posts (GF) OR(95% Cr.I.)=0.46 (0.04 – 5.47).

Moreover, the amount of post fracture in prefabricated

glass fabric is less than metal prefabricated posts ((PM)

OR(95% Cr.I.)=0.82 (0.13 – 7.15).

In the case of treatment failure due post Fracture in

(RCT+cohort) studies, the amount of post Fracture in

cast metal posts is less than prefabricated metal (PM)

OR(95% Cr.I.)=0.31 (0.12 – 0.87), and also less than glass

prefabricated posts (GF) OR(95% Cr.I.)=0.42 (0.21 – 1.06)

. Moreover, the amount of post fracture in prefabricated

glass fabric is a little less than metal prefabricated posts

((PM) OR(95% Cr.I.)=0.73 (0.16 – 2.39).

In case of treatment failure due to the endodontic,

Periodontics and decay in cohort studies, the amount

of endodontic Periodontics and decay problems in glass

pre-fabricated posts is less than metal prefabricated(PM)

OR (95% Cr.I.)=0.39 (0.04 – 3.94) and less than cast metal

OR (95% Cr.I.)=0.52 (0.07 – 4.61)(CM ). In addition, the

amount of endodontic, Periodontics and decay problems

in cast metal posts is less than metal prefabricated posts

(PM) OR (95% Cr.I.)=0.79 (0.39 – 1.79).

In case of treatment failure due to the endodontic,

Periodontics and decay in RCT studies, the amount of

endodontic Periodontics and decay problems in cast

metal posts is less than metal prefabricated(PM) OR(95%

Cr.I.)=0.39 (0.05 – 2.32) and also less than glass prefabri-

cated posts OR(95% Cr.I.)=0.58 (0.11 – 2.06). In addition,

the amount of endodontic, Periodontics and decay prob-

lems in glass prefabricated posts is less than metal pre-

fabricated posts (PM) OR(95% Cr.I.)=0.65 (0.24 – 1.59).

In case of treatment failure due to the endodon-

tic, Periodontics and decay in RCT+Cohort studies, the

amount of endodontic Periodontics and decay problems

in cast metal posts is less than metal prefabricated(PM)

OR(95% Cr.I.)=0.79 (0.37 – 1.58) and also equal with

glass prefabricated posts OR(95% Cr.I.)=1.00 (0.47 –

1.95). In addition, the amount of endodontic, Periodon-

tics and decay problems in glass prefabricated posts is

less than metal prefabricated posts (PM) OR(95% Cr.I.)=

0.83 (0.33 – 1.65).

In case of treatment failure due to root fracture in

cohort studies, the amount of root fracture in glass pre-

fabricated posts (GF) is less than metal prefabricated

(PM) OR(95% Cr.I.)=0.31 (0.06 – 1.04), and less than cast

metal (CM) OR(95% Cr.I.)=0.34 (0.12 – 0.91). In addi-

tion, root fracture in cast metal (GF) posts is less than

metal prefabricated posts (PM)OR(95% Cr.I.)=0.84 (0.29

– 2.20).

In case of treatment failure due to root fracture in

RCT studies, the amount of root fracture in glass prefab-

ricated posts (GF) is less than metal prefabricated (PM)

(PM) OR(95% Cr.I.)=0.46 (0.05 – 2.63), but, root fracture

in metal cast posts (CM) is less than glass prefabricated

(GF)OR(95% Cr.I.)=0.64 (0.05 – 2.62), and metal prefab-

ricated (PM) OR(95% Cr.I.)=0.28 (0.01 – 2.39).

22 RECONSTRUCTING ROOT TREATED TEETH USING POST AND CORE – A SYSTEMATIC REVIEW BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Moradpoor, Raissi and Bardideh

In case of treatment failure due to root fracture in

RCT+cohort studies, the amount of root fracture in glass

prefabricated posts (GF) is less than metal prefabricated

(PM) OR(95% Cr.I.)=0.36 (0.19 – 0.86) and less than cast

metal (CM) OR(95% Cr.I.)=0.56 (0.27 – 1.33). In addi-

tion, root fracture in cast metal (CM) posts is less than

metal prefabricated posts (PM)OR(95% Cr.I.)=0.62 (0.29

– 1.57).

About all the treatment failures in Cohort studies,

glass prefabricated posts (GF) is less than metal prefab-

ricated OR (95% Cr.I.)=0.11 (0.03 – 0.32) (PM), and less

than cast metal OR (95% Cr.I.)=0.21 (0.07 – 0.53)(CM). In

addition, all treatment failures in cast metal posts (CM)

is less than metal prefabricated posts OR (95% Cr.I.)=

0.51 (0.27 – 0.95)(PM).

Moreover, all treatment failures in glass prefabricated

posts is less than metal prefabricated OR(95% Cr.I.)=0.36

(0.13 – 0.90)

About all the treatment failures in RCT studies,

amount of treatment failure of cast metal posts is less

than metal prefabricated (PM) OR(95% Cr.I.)=0.19 (0.06

– 0.62) and glass prefabricated (GF) OR(95% Cr.I.)=0.54

(0.31 – 0.92). In addition, all treatment failure in glass

prefabricated posts is less than metal prefabricated posts

OR(95% Cr.I.)=0.36 (0.13 – 0.90).

About all the treatment failures in RCT +Cohort stud-

ies, amount of treatment failure of cast metal posts is

less than metal prefabricated (PM) OR(95% Cr.I.)= 0.45

(0.20 – 0.99) . Treatment failure of glass prefabricated

posts is less than metal cast OR (95% Cr.I.)= 0.74 (0.34

– 1.32). In addition, all treatment failure in glass prefab-

ricated posts is less than metal prefabricated posts OR

(95% Cr.I.)= 0.33 (0.14 – 0.74).

In RCT studies, cast posts in all aspects of treatment

failure (loss of stuck, post fracture, root fracture, endo-

FIGURE 1. Post fracture

FIGURE 2. Root fracture

FIGURE 3. Ferrule effect

dontic problems, periodontics and dental caries) had a

lower failure rate than other posts (PM, GF), they were

the best posts for tooth restoration. Metal prefabricated

posts had the highest amount of treatment failure in all

the aspects, and they are the worst posts for tooth resto-

ration. In Cohort studies, glass prefabricated posts ( ber

posts) in all aspects of had a lower failure rate than cast

metal. Like RCT, metal prefabricated posts had the high-

est amount of treatment failure in all the aspects, and

they are the worst posts for tooth restoration.

In (RCT+Cohort) studies, root fracture and total fail-

ures in  ber posts is less, however, the amount of post

fracture in metal cast posts is less. In losing stuck, and

failure due to endodontic, Periodontics and decay, the

amount of clinical failure of  ber posts and cast metal

was equal. Metal prefabricated posts still had the highest

amount of treatment failure in all aspects, and they were

the worst posts for tooth restoration.

Moradpoor, Raissi and Bardideh

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS RECONSTRUCTING ROOT TREATED TEETH USING POST AND CORE – A SYSTEMATIC REVIEW 23

In the present study, for the  rst time, various aspects

of treatment failure were examined separately in differ-

ent systems of post (loss of stuck, failure in endodontic,

Periodontics and decay, post fracture, and root frac-

ture) in primary studies of Cohort and RCT. In addition,

for the  rst time, Network Metal- analysis was used to

examine 2 different treatment methods to reconstruct

root treated teeth.

As the result of Network Metal- analysis on the primary

studies of RCT, in all levels of treatment failure aspects (loss

of stuck, failure in endodontic, Periodontics and decay, post

fracture, and root fracture), and in all treatment failures,

cast posts had the less failure than other posts (PM.GF), and

they were the best posts to restore teeth. The mentioned

results aligned with the studies of Figueiredo et al (Figue-

iredo 2015), and Zhou et al (Zhou 2013), but they are in

contrast with the results of Bolla (Bolla 2007).

Of course, in the study of Figueiredo, root fracture

rate was considered equal among all cast metal and  ber

posts that are in contract with the results of the present

study. In addition, in meta-analysis of RCT studies, metal

prefabricated posts had the highest rate of treatment

failure in all aspects, and they were the worst posts for

tooth restoration, which were studied just in the study of

Figueiredo, and in comparison with cast metal posts. In

the mentioned study, treatment failure rate of them was

twice higher than cast metal posts.

In primary studies of Cohort, in all levels of treatment

failure aspects and in all treatment failures, glass prefab-

ricated posts ( ber posts) had the less failure than metal

posts (whether cast, or prefabricated). The mentioned

results aligned with the studies of Bolla et al and Soarez

et al. like RCT, metal prefabricated posts had the highest

rate of treatment failure in all aspects, and they were the

worst posts for tooth restoration. In (RCT+Cohort) stud-

ies, root fracture rate is less in  ber posts, but post frac-

ture rate in cast metal posts is less. In addition, in loss

of stuck and failure due to endodontic, Periodontics and

decay problems, the rate of clinical failure of  ber casts

and cast metal was the same, which has not been studied

in another survey. In total, treatment failure of  ber posts

was less than cast metal. Metal prefabricated posts had

still the highest rate of treatment failure in all aspects, and

they were the worst posts for tooth restoration.

The study of Figueiredo et al was conducted in 2015,

in which, such as the present study, both random and

Cohort studies were used. However, due to using Onearm

Cohort studies that studies just one post without com-

paring with other posts, there was not possibility to con-

duct meta-analysis between Cohort and RCT studies in

the mentioned study.

Besides, the results were just in the form of reviewing

survival average difference among different posts, and

odd ration was not examined among various posts. Of

course, this study is the only one that has studied metal

prefabricated posts, of course, just with cast metal posts,

and has informed their fracture rate to be twice more

than that of metal cast posts. Moreover, root fracture

rate between cast metal posts and  ber posts were equal

that are in contrast with our study results.

Study of Zhou and et al was released in 2013 in Chi-

nese in which about 13 studies were analyzed and the

only general failure of treatment was evaluated. Metal

posts had a signi cant lower rate of failure rather than

 ber posts that the result of the study is aligned with

our RCT meta-analysis, but in contract with our Cohort

meta- analysis and total result.

The review study of Soarez et al in 2012 was con-

ducted on just the non-random primary studies I nwhich

the studies were reviewed separately, and any meta-anal-

ysis was not done on them. Finally, failure rate of metal

posts was more than glass posts. The result is aligned

with our meta-analysis on Cohort and total studies, but

is not aligned with our RCT meta-analysis results.

In study of Bolla et al in 2005, just one study was

included in meta-analysis. Finally, the result was that

glass posts have less failure rather than metal posts. The

result is in contrast with our RCT meta- analysis result

that is probably because of few numbers of primary

studies in Bolla meta- analysis. As it is observed, meta-

analysis results of Cohort studies and random clinical

trial are different between  ber post and metal cast in all

aspects. In random studies, metal cast post in all aspects

in the best post, and in Cohort studies, almost in all

aspects,  ber posts are the best. Therefore, to compare

the results of Cohort and random clinical studies, there is

a great heterogeneity even when using Random-effects.

(Heterogeneity (Vague) = 1.11, Heterogeneity (Inform.) =

0.472895% CrI (0.0821 – 0.9902))

As the result, the  nal result of analysis, according to

(Cohort+RCT) studies and in contract with separate meta-

analysis of Cohort studies, RCT has a wide range of OR

(0.74 (0.34 – 1.32 for Random-Effects) and 0.92 (0.60 –

1.35) for Fixed Effects) which must be noted while consid-

ering the results. Moreover, if using Random-effects, the

total failure result in (Cohort+RCT) studies has a different

result (superiority of  ber posts) rather than using Fixed-

Effects (equality of  ber posts and cast metal) that must

be noted when exploiting the present study.

CONCLUSION

According to RCT studies, cast metal posts had the low-

est and metal prefabricated posts have the highest rate

of failure in all aspects. According to Cohort studies,

glass prefabricated posts ( ber posts) had the lowest rate

of failure in all aspects. Metal prefabricated posts had

Moradpoor, Raissi and Bardideh

24 RECONSTRUCTING ROOT TREATED TEETH USING POST AND CORE – A SYSTEMATIC REVIEW BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

the highest rate of failure in all aspects. According to

(Cohort+RCT) studies, cast metal posts has the lowest

failure rate regarding post fracture, and  ber posts had

the lowest root fracture and lowest total failure. Rate

of stuck loss and failure due to endodontic, periodon-

tics and dental caries problems, rate of clinical failure

of  ber posts and metal cast were equal. Prefabricated

metal posts had the highest rate of failure in all aspects.

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