Root canal posts for the restoration of root filled teeth

Bolla M, Muller-Bolla M, Borg C, Lupi-Pegurier L, Laplanche O, Leforestier E

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Summary

Root canal posts for the restoration of root filled teeth

There is weak evidence from one trial of 200 people that carbon fibre posts have fewer failures after 4 years than metal-cast posts. More research is needed.
Root canal posts are placed in teeth that have lost an extensive amount of tooth structure because of decay, failed fillings (restorations) or tooth fractures. Post and core systems can be metal or non-metal and provide a way to securely anchor the filling material core to the tooth. The core is retained by the post and the tooth can then be restored with a crown. The post is inserted into the root canal of an endodontically-treated tooth. Thus it provides retention for the final restoration. In one study, non-metal posts induced fewer failures. Thus more research is necessary to indicate which system should be used for different clinical cases.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Bolla M, Muller-Bolla M, Borg C, Lupi-Pegurier L, Laplanche O, Leforestier E. Root canal posts for the restoration of root filled teeth. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004623. DOI: 10.1002/14651858.CD004623.pub2.

This version first published online: January 24. 2007

Abstract

Background

The foundation for the reconstruction of endodontically-treated teeth can be provided by a metal or a non-metal post and core system but no guidelines exist for choosing one or the other in particular clinical cases.

Objectives

To assess the effectiveness of different post and core systems for the restoration of endodontically-treated teeth. The primary objective of this review was to compare the clinical failure rates of the different types of posts.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3), MEDLINE (from 1966 to September 2005), Scopus (from January 1985 to December 2004) and EMBASE (until December 2004). We looked through reference lists of articles and dental conference proceedings. We contacted researchers in the field and manufacturers.

Selection criteria

Randomised or quasi-randomised clinical trials (RCTs) comparing failures on endodontically-treated permanent teeth with different types of post. The outcomes were loss of retention, post fracture and root fracture.

Data collection and analysis

Two review authors independently assessed the quality of trials and extracted data. Study authors were contacted for additional information.

Main results

Two trials involving 317 participants were included but only one of them, involving 200 participants, compared metal to non-metal posts. The other answered to the secondary objective. The risk of failure was greater with metal-cast posts (9/98) compared to carbon fibre posts (0/97) (risk ratio (RR) = 0.05 (95% confidence interval (CI) 0.00 to 0.90)) but the study was at high risk of bias. Thus fewer failures occurred when using non-metal posts but the evidence is unreliable.

Authors' conclusions

Our systematic review could not specify which type of post and core system should be used when two or three dentine walls remain. More RCTs are needed to confirm whether fibre-reinforced post and core systems are superior and to clarify the influence of the remaining tooth structure on the treatment outcome of the different post and core systems available. Well-defined inclusion criteria focusing on the number of dentine walls (two or three) should be used.

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