Article

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: 0.73). 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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    • "modulus of elasticity close to that of the dentin and, when bonded using resin cements and composite resins, are able to form a single unit, resulting in minimal tension to the root dentin when compared to cast posts.[3] [5] [7] Light activation is necessary for some dual-cure and light-cure cements, however, light propagation decreases through to the middle and apical thirds of the root, compromising bonding.[8] "
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    • "However, even though endodontic post and core may be considered a feasible treatment for endodontically-treated teeth, most traditional restorative techniques such as Nayyar cores [5] or Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/ijadhadh cast post-cores require the removal of a vast amount of sound tooth structure to create a dowel/post space [4]. Minimally invasive restorations of endodontically-treated teeth are made possible by the use of new generation dentine bonding systems and composite resins that are bonded to the residual coronal root dentine as well as root canal dentine without the use of endodontic posts [6]. "

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