Clinical trials of fiber posts: A literature review

Department of Preventive Dentistry and Periodontics, School of Dental Medicine, University of Siena, Siena, Italy.
The International journal of prosthodontics (Impact Factor: 1.46). 07/2008; 21(4):328-36.
Source: PubMed


This literature review aimed to find answers to relevant questions regarding the clinical outcome of endontically treated teeth restored with fiber posts.
All clinical studies published since 1990 in journals indexed in MEDLINE were retrieved by searching PubMed with the query terms "fiber posts and clinical studies." The reference list of the collected articles was also screened for further relevant citations. The strength of the evidence provided by the reviewed papers was assessed according to the criteria of evidence-based dentistry.
Five randomized controlled trials (RCTs) on fiber posts have been published in peer-reviewed journals. A meta-analysis is not applicable to these studies since they do not address the same specific clinical question. Retrospective and prospective trials without controls are also available.
Two RCTs indicate that fiber-reinforced composite posts outperform metal posts in the restoration of endontically treated teeth. However, this evidence cannot be considered as conclusive. Longer-term RCTs would be desirable. The placement of a fiber-reinforced composite post protects against failure, especially under conditions of extensive coronal destruction. The most common type of failure with fiber-reinforced composite posts is debonding.

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Available from: Marco Ferrari, Mar 12, 2014
    • "One of the concerns in reinforcing procedures is the establishment of efficient bonds between components such as dentin, resin cement, resin composite, and the fiber post. Although numerous researchers affirmed that loss of post retention was the most prevalent failure mode,[931] none of the specimen in this study showed this failure type. This event could be related to the intentional enlargement of root canals. "
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    ABSTRACT: Background: Glass and quartz fiber posts are used in restoration of structurally compromised roots. Accessory fiber posts are recently introduced to enhance the fiber post adaptation. This study evaluated the effectiveness of glass versus quartz accessory fiber posts. Materials and Methods: In this experimental study, 40 mandibular premolar roots with similar dimension (radius of 3.5 ± 0.2 mm and length of 13 ± 0.5 mm) were selected and their root canals were flared until 1.5 mm of dentin wall remained. They were randomly assigned to four groups (n = 10) and restored as follows: Exacto glass fiber post (EX), Exacto glass fiber post + 2 Reforpin accessories (EXR), D. T. Light quartz fiber post (DT), and D. T. Light quartz fiber post + 2 Fibercone accessories (DTF). All posts were cemented with Duo-Link resin cement and the cores were built with the particulate filler composite. Following 1-week water storage, specimens were subjected to fracture loads in a universal testing machine. The maximum loads and failure modes were recorded and analyzed with the two-way analysis of variance (ANOVA) and Fisher's exact tests (α = 0.05). Results: The mean fracture resistance values (N) were 402.8 (EX), 378.4 (EXR), 400.1 (DT), and 348.5 (DTF). Two-way ANOVA test showed neither reinforcing method (P = 0.094), nor post composition (P = 0.462) had statistically significant differences on fracture resistance of the structurally compromised premolar teeth. Fisher's exact test also demonstrated no statistically significant difference regarding two variables (P = 0.695). Core fracture was the most common failure mode (62.5%). Conclusion: Glass and quartz fiber posts with or without accessories restored the weakened premolar roots equally.
    Dental research journal 03/2014; 11(2):264-71.
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    • "Restoration of endodontically treated teeth with fiber posts and composite core systems has been extensively investigated over the past 20 years (Schwartz and Robbins, 2004; Peroz et al., 2005). Although low percentages of failure rates and satisfactory clinical performance were reported when fiber posts were used (Ferrari et al., 2007a; Schmitter et al., 2007; Cagidiaco et al., 2008b), pulpless teeth are still considered vulnerable and more susceptible to fracture compared with vital teeth (Tang et al., 2010). The survival of endodontically treated and restored teeth depends on many baseline factors (Naumann et al., 2005), among which the amount of remaining coronal structure, restorative procedures, and material selection (Schwartz and Fransman, 2005; Tang et al., 2010) seem to be key factors affecting tooth longevity. "
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    ABSTRACT: Objective: To assess whether the amount of residual coronal structure and the placement of a prefabricated fiber posts luted with a self-adhesive cement or a composite core material may affect the four-year survival of root filled premolars. Method: A sample of 120 patients provided 2 cohorts of 60 premolars needing endodontic treatment. Cohorts were defined depending on the amount of residual coronal dentin after abutment build-up and final preparation: Group A: more than 50% of coronal residual structure and at least 2 sound residual walls; Group B: less than 50% of coronal residual structure and less than 2 sound residual walls. However, at least one residual wall and a 1.5 mm ferrule was present. Teeth were randomly divided into two Subgroups (n=30) accordingly to the material used for luting posts. In Subgroup 1 a core material, (Gradia Core, GC Co., Tokyo, Japan, CM) was used, while in Subgroups 2 posts were luted using a self-adhesive cement (GCem, GC Co., SAC). Teeth were finally restored with single unit metal-ceramic crowns. Result: Data were not affected by any loss to follow-up. The presence of more than 50% of coronal residual structure was a significant factor for survival (p<0.05). The highest 48-months survival rate of crowned endodontically treated premolars was 90.0% for fiber posts luted with CM and with more than 50% of residual coronal structure. The lowest survival rate was recorded for fiber posts luted with SAC on abutments with less than 50% of coronal residual structure (73.3%). Clinical failure was mainly due to loss of retention, post debonding or crown dislodgement. Conclusion: The amount of residual coronal structure affects the four-year survival of filled premolars. The highest clinical success rate may be achieved when luting fiber posts with a core material on abutments with more than 50% of residual coronal structure.
    IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
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    • "Cast posts and cores have been used for this purpose for many years, while more recently fiber posts showed to represent a valid alternative. The clinical success of fiber post restorations is mainly related to their biomechanical properties that, being close to those of dentin, reduce stress transmission to the roots [6] [7] [8] [9]. The potential of fiber posts to reduce the incidence of nonretrievable root fractures in comparison with cast posts was confirmed in several studies [10] [11] [12]. "
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    ABSTRACT: Purpose. The analysis of the complex model of fiber post and ferrule is given and studied in this paper. A novel approach and a solution to the evaluation of stress of post and core system within the ferrule effect are proposed. Methods. Sixty freshly extracted premolars were selected for the study. The following experimental groups were therefore defined (n = 10): (1) 5 mm, (2) 7 mm, (3) 9 mm, (4) ferrule-5 mm, (5) ferrule-7 mm, and (6) ferrule-9 mm. Preshaping drills (C) were used to prepare the root canals at 5, 7, and 9 mm in depth. In specimens of groups 3–6 a circumferential collar of tooth structure of 2 mm in height. Fluorocore 2 core build-up material (I) was used for fiber post luting. With the same material, a buildup of 2 mm in height was created. A controlled compressive load (crosshead speed: 0.75 mm/min) was applied by means of a stainless steel stylus (Ø 1 mm) at the coronal end of the post extruding out of the root. Results. In all the tests the level of significance was set at P < 0.05 . Significantly higher fracture strengths were measured in the presence of a ferrule effect. In groups 1, 2, and 3 (ferrule group), the mean fracture values were, respectively, 163,8 N, 270,9 N, and 254,7 N. These data are higher and statistically significantly different when compared with the three groups 4, 5, and 6 (no-ferrule group), in which the values obtained were, respectively, 40,5 N, 41,7 N, and 44,9 N. Conclusion. The ferrule effect in the endodontically treated teeth positively affects the fracture strength of the fiber post. Conversely, post depth insertion did not affect the resistance to fracture.
    Computational and Mathematical Methods in Medicine 12/2012; 2012:816481. DOI:10.1155/2012/816481 · 0.77 Impact Factor
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