Randomized clinical trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months

By Bitter K, Noetzel J, Stamm O, Vaudt J, Meyer-Lueckel H, Neumann K, Kielbassa AM

Date: 07/2010
Journal: JOE

Purpose:  to investigate the time to failure of endodontically treated anterior and posterior teeth restored with a single-unit final restoration with and without posts.

Materials and Methods:

•90  patients in need of a postendodontic restoration (120 teeth).

•Inclusion criteria:

1) fit to the groups.

2) minimum apical seal of 4 mm and no PA lesion.

3) no or no untreated advanced periodontitis with a maximum pocket depth of 5 mm without bleeding on probing.

4)less than grade 1 mobility. 

5) no more than 1 grade furcation.

6) recall interval of at least 3 years.

Group 1 (2-walls)

•A) no post (n=20)

•B) post (n=20)

Group 2 (1-wall)

•A) no post (n=19)

•B) post (n=20)

Group 3 (no walls)

•A) no post (n=21)

•B) post (n=20)

Groups wiith no post: gutta percha removal to a depth of 3 mm from canal orifice, core buildup and crown or composite direct restoration •Groups with post: DT Light post 7-8 mm length (leaving at least 4 mm apical seal) – post size (2 or 3) – minimal coronal length of the post was 3 mm – post cementation and core using Clearfil Core/New bond

•Patients were followed up up to 56 months

•25 anterior teeth and 95 posterior teeth analyzed

•After 12 and 36 months RG using parallel technique and examined by one blinded operator to exclude the possibility of radiographic signs of failure. •Primary end point: loss of restoration for any reason

Secondary end point: post debonding, post fracture, vertical or horizontal tooth fracture, failure of the core portion requiring a new coronal restoration, endodontic or periradicular conditions requiring endodontic retreatment, and tooth loss.

•Evaluation of success or failure was performed by one examiner who was not the operator by using a mirror and a probe to detect marginal gap formation of the restorations.

Most highlighted Results:  

•Mean observation period of 32.4 months.

•Overall failure rate, in groups with no post (regardless of remaining walls), the failure rates were 10%, whereas in groups with post, failure rates of 7% were observed (not significant).

•In no-wall group, teeth without post retention revealed a significantly higher failure rate (31%) compared with teeth restored with post retention (7%).

Clinical significance:

In teeth with no coronal walls post placement should be considered.