A Systematic Review of Dowel (Post) and Core Materials and Systems

Journal of Prosthodontics (Impact Factor: 1.07). 07/2009; 18(6):464-72. DOI: 10.1111/j.1532-849X.2009.00472.x
Source: PubMed


The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth.
A MEDLINE, a Cochrane, and an EMBASE search (three specified searches) were conducted to identify randomized (RCT) and nonrandomized controlled clinical trials (CCT), cohort (CS), and case control studies (CCS) until January 2008, conducted on humans, and published in English, German, and French, relating to dowel and core systems for restoring endodontically treated teeth. Also, a hand search was conducted, along with contact with the authors when needed.
The MEDLINE, Cochrane, and EMBASE searches identified 997, 141, and 25 published articles, respectively. Ten articles from the MEDLINE and seven articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. Six out of the ten studies were RCTs, two were CCTs, and two CSs. The RCT studies suggest that carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (number needed to treat, NNT = 8.30). Tapered gold alloy cast dowels are better than ParaPost gold alloy cast dowels (NNT = 13.15). ParaPost prefabricated dowels are slightly better than ParaPost cast dowels (NNT = 175.4). Glass fiber dowels are significantly better than metal screw dowels (NNT = 5.46), but worse than titanium (NNT =-21.73) (moderately). Carbon fiber dowels are worse than gold alloy cast dowels (significantly) (NNT =-5.81) and than amalgam dowels (NNT =-125) (slightly). The CCT studies suggest that metal dowels are better (NNT = 21.73) but also worse than cast dowels (NNT =-33.33) depending on the remaining amount of coronal hard tissue. Quartz fiber dowels show success rates similar to and worse than glass fiber-reinforced dowels (NNT =-37.03). The results from the CS studies suggest that carbon fiber in resin matrix dowels are better (moderately) than carbon fiber + quartz and quartz fiber dowels. Titanium dowels with a composite build-up are better (moderately) than gold alloy cast dowels.
According to the studies of the highest levels of evidence, carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (RCT). Glass fiber dowels are significantly better than metal screw dowels (RCT) and moderately better than quartz fiber dowels (CCT). Carbon fiber dowels are significantly worse than metal dowels (of precious alloy) (RCT). Prefabricated metal dowels are slightly better than cast dowels (RCT), but moderately worse when no collar of the dentin above the gingiva could be achieved (CCT).

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Available from: Joanna N Theodosopoulou, Oct 05, 2015
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    • "A recent systematic review of post and core materials conducted by Theodosopoulou and Chochlidakis [65] was based on articles found in an electronic search of MEDLINE from 1966 to 2008, and a Cochrane and EMBASE search from 1945 to 2008. It was aimed to determine which post and core system is the most successful when used in vivo to restore endodontically treated teeth. "
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    ABSTRACT: Coronal restorations and posts can positively influence the long-term prognosis of teeth following root canal therapy. Final sealing the canal by placing an appropriate post and core will minimize leakage of oral fluids and bacteria into the periradicular area and is recommended as soon as possible after completion of root canal filling. Glass ionomer or MTA placed over the residual root canal filling after post space preparation may be effective to prevent bacterial leakage. A ferrule of 1-2 mm of tooth tissue coronal to the finish line of the crown significantly improves the fracture resistance of the tooth and is more important than the type of the material the core and post are made of.
    International Journal of Dentistry 01/2009; 2009(1687-8728):150251. DOI:10.1155/2009/150251
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    ABSTRACT: The authors searched MEDLINE, EMBASE, CENTRAL, and Scopus electronic databases through 2004 for eligible articles. The authors also searched International Association for Dental Research conference proceedings and abstracts from 1996-2004 and contacted manufacturers and other known experts to identify unpublished studies. Studies had to be randomized or quasi-randomized clinical trials (RCT) evaluating failures of endodontically-treated permanent teeth with different post types. This systematic review included one clinical study related to answering the primary objective, and this study involved 200 patients, 100 receiving a fiber post and 100 receiving a cast metal post. A second clinical study was included as related to a secondary objective and that study involved 117 patients, with 60 receiving a composite resin restoration as the definitive treatment after placement of a fiber post and 57 receiving a complete coverage metal ceramic crown as the definitive treatment after a fiber post had been placed. The primary treatment of interest was the type of post used, metal versus non-metal. A secondary interest was the prosthetic status of the tooth, carbon fiber post followed by a composite resin restoration versus a carbon fiber post followed by a metal ceramic crown. The main measure used to evaluate treatment effectiveness for the primary objective (metal versus non-metal post) and the secondary objective (composite resin definitive restoration versus metal ceramic crown) was post failure. Regarding the study addressing the primary objective, the fiber post resulted in fewer failures (0/97) than the conventional cast post and core system (9/98) after 4 years of clinical service. The risk ratio (RR) = 0.05, and there was a 95% confidence interval (CI) of 0.00 to 0.90. This study was judged to be at high risk of bias. Root fracture was the only failure encountered in the cast post and core group. The results suggest fiber posts may be more successful than cast metal posts, but there were not enough RCTs to warrant a definitive recommendation.
    The journal of evidence-based dental practice 03/2010; 10(1):32-4. DOI:10.1016/j.jebdp.2009.11.023
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    ABSTRACT: The purpose of this study was to compare the tensile strength of commercially pure titanium dowels and cores cemented with zinc phosphate or resin cements. Twenty-one extracted human canines were endodontically treated. The root preparations were accomplished using Largo reamers (10mm in depth and 1.7 mm in diameter). Acrylic resin patterns for the dowel and cores were made, and specimens were cast in commercially pure titanium (n=7) and divided in three groups: TZ-CP Ti dowels luted with zinc phosphate luting agent, TP-CP Ti dowels luted with Panavia F and TR-CP Ti dowels luted with RelyX U100. Tensile strengths were measured in a universal testing machine at a crosshead speed of 0.5mm/min. The results (N) were statistically analyzed by ANOVA and Tukey tests (α=0.01). The ANOVA indicated that there were significant differences among the groups tested. A Tukey multiple comparison procedure was performed and revealed statistically significant higher retention values for the dowel luted with RelyX U100 when compared with zinc phosphate or Panavia F. Cast commercially pure titanium dowels and cores fixed with RelyX U100 cement presented superior bond strength retention when compared to zinc phosphate and Panavia F.
    04/2010; 54(4):164-7. DOI:10.1016/j.jpor.2010.03.002
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