Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature, Part II (Evaluation of fatigue behavior, interfaces, and in vivo studies).

Department of Cariology and Endodontics, School of Dentistry, University of Geneva, Geneva, Switzerland.
Quintessence international (Berlin, Germany: 1985) (Impact Factor: 0.64). 03/2008; 39(2):117-29.
Source: PubMed

ABSTRACT OBJECTIVE: The restoration of endodontically treated teeth has long been guided by empirical rather than biomechanical concepts. Part I of this literature review presented up-to-date knowledge about changes in tissue structure and properties following endodontic therapy, as well as the behavior of restored teeth in monotonic mechanical tests or finite element analysis. The aim of the second part is to review current knowledge about the various interfaces of restored, nonvital teeth and their behavior in fatigue and clinical studies. REVIEW METHOD: The basic search process included a systematic review of articles contained in the PubMed/Medline database, dating between 1990 and 2005, using single or combined key words to obtain the most comprehensive list of references; a perusal of the references of the references completed the review. RELEVANT INFORMATION AND CONCLUSIONS: Nonvital teeth restored with composite resin or composite resin combined with fiber posts resisted fatigue tests and currently represent the best treatment option. In comparison to rigid metal and/or ceramic posts, when composite resin or composite resin/fiber posts fail, the occurrence of interfacial defects or severe tooth breakdown is less likely. Adhesion into the root, however, remains a challenge because of the unfavorable ovoid canal configuration, as well as critical dentin microstructure in the deepest parts of the canal. Thus, specific combinations of adhesives and cements are recommended. The clinical performance of post-and-core restorations proved satisfactory overall, in particular with a contemporary restorative approach using composite resin and fiber posts. However, the clinical literature does not clearly isolate or identify exact parameters critical to success. This, in turn, emphasizes the importance and relevance of in vitro studies to further improve the quality and long-term stability of prosthetic foundations.

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    ABSTRACT: The restoration of endodontically treated teeth is one of the most challenging situations of the dentist’s clinical practice, because it involves procedures related to several areas, such as endodontics, operative dentistry, and prosthetic dentistry. The restoration of endodontically treated teeth is a topic that is extensively studied and yet remains controversial from many perspectives. This article reviews the major pertinent literature on this topic, with an emphasis on major decision-making elements in proper post selection and restoration of endodontically treated teeth. Most endodontically treated teeth require a post and core build-up for restoring the teeth to optimum health and function. Selection of an appropriate post-and-core system from the wide variety of those available may be a clinical dilemma. Selection of a post and core system should satisfy many interrelated biologic, mechanical, and esthetic factors to optimally restore the endodontically treated tooth to adequate form and function. It is also important to remember that the prognosis of endodontically treated teeth depends not only on endodontic treatment success itself, but also on the amount of remnant tooth tissue and the definitive restoration that will be placed onto the dental element. This review may serve as a guide to aid the clinician in the selection of a post and core system.
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    ABSTRACT: The aim of this study was to evaluate the influence of cement type and relining procedure on push-out bond strength of fiber posts (FPs) after cyclic loading. Forty bovine incisor roots were divided into four groups: group 1, FP luting with RelyX Unicem; group 2, FP relined with resin composite (FPC) luting with RelyX Unicem; group 3, FP luting with RelyX ARC; group 4, FPC luting with RelyX ARC. Afterwards, half the specimens were exposed to 250,000 cycles in a controlled chewing simulator. With the other half of the specimens in each group, the push-out test was performed 24 hours after FP luting (immediate groups). All roots were sectioned transversely, producing 1-mm-thick slices, and the push-out test was performed. Statistical analysis was performed using ANOVA and the Tukey test for post hoc comparisons (α = 0.05). FPC had higher bond strengths than FP (p < 0.05). RelyX Unicem showed higher bond strength than RelyX ARC (p < 0.05). Cyclic loading did not significantly affect the bond strength value (p > 0.05). The relining procedure and the cement type are important factors for the bond strength of FPs to root dentin. © 2015 by the American College of Prosthodontists.
    Journal of Prosthodontics 02/2015; DOI:10.1111/jopr.12271 · 0.68 Impact Factor
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    ABSTRACT: The effects of different post-space pretreatments on the retentive force of fiber posts cemented with a self-adhesive resin cement were investigated. Twenty-eight single-canal premolars were obturated by Resilon using warm vertical compaction and treated with distilled water, 2.5% NaOCl, 17% EDTA and 2.5% NaOCl; or 17% EDTA, 2.5% NaOCl, and ultrasonic agitation (U/E/N treatment). Subsequently, radicular dentin surfaces were observed under scanning electron microscopy (SEM). RelyX Fiber Posts were cemented in the treated canals by using RelyX U100, and thin-slice push-out test and SEM observation of coronal and apical regions of the specimens were performed. Data were analyzed using two-way ANOVA and Tukey’s HSD posthoc tests, and the percentage of failure type was calculated. Ultrasonic/EDTA/NaOCl irrigation showed the maximum effectiveness in removing the smear layer and debris on the dentin surface. The apical bond strength of the experimental groups was significantly higher than that of the control group (P< 0.05). Adhesive failure between cement and dentin was the most common mode of failure. No obvious RDIZ or resin tag was detected. Chemical irrigants facilitated the bonding of these fiber posts, and ultrasonic activation improved retention. Future studies should evaluate the effectiveness of irrigation on fiber post push-out strength in fatigue cycling condition.
    Journal of Wuhan University of Technology-Mater Sci Ed 10/2013; 28(5):984-989. DOI:10.1007/s11595-013-0805-3 · 0.42 Impact Factor


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