Post-and-core crown is one of the most common forms of restoration of tooth after root canal therapy (RCT). Infection control is the core objective of RCT, which is usually well realized by endodontists. However, many prosthodontists often neglect the infection control of the tooth and the maintenance of the curative effect of RCT during the process of post-and-core crown, which may lead to the failure of the final restoration. The concept of integrated crown-root treatment advocated recently requires clinicians to consider the RCT and final restoration as a whole, rather than simply divided into two parts-endodontic treatment and restorative treatment. As the core content of integrated crown-root treatment, infection control should be taken seriously by clinicians and implemented throughout the whole treatment process, especially in the restorative treatment that is easily overlooked after RCT. Therefore, this article describes the infection control of post-and-core crown restoration, classifies the tooth requiring post-and-core crown restoration, and puts forward the measures of infection control before and during post-and-core crown restoration, in order to provide reference and guidance for clinical practice.
Humans ; Crowns ; Tooth Crown ; Post and Core Technique ; Root Canal Therapy ; Infection Control ; Tooth Fractures

Many patients with large-area tooth defect need cast post-core crown restoration. However, the color defect of the cast post-core will affect the final restorative result, especially that of the anterior teeth. A new technology of color masking by applying CERAMAGE polymeric porcelain to the cast metal post-core surface improves the color of a full-ceramic restoration of anterior teeth and may provide a new alternative for the aesthetic repair of anterior teeth with a large area of defective tooth.
Ceramics ; Crowns ; Dental Porcelain ; Esthetics, Dental ; Humans ; Post and Core Technique

Fiber-reinforced resin composite posts (fiber posts) are used extensively for the restoration of root-treated teeth with excessive loss of coronal structure. However, the longevity of a fiber post restoration still needs to be improved because of the various confounding factors that affect bonding procedures. Operational specification for clinical use of dental intraradicular fiber post was established based on the in-depth discussions by a panel of experts from Society of Prosthodontics, Chinese Stomatological Association. This specification should be helpful in standardizing the clinical technique of fiber post placement and improving the clinical longevity of a fiber post restoration.
Cementation ; Composite Resins ; Dental Bonding ; Dental Stress Analysis ; Glass ; Materials Testing ; Post and Core Technique ; Resin Cements ; Tooth Root

OBJECTIVE: To evaluate the modified micro-push-out bond strengths of prefabricated glass fiber posts with silaneafter 35% phosphoric acid to resin cements. METHODS: In the study, 40 glass fiber posts were randomly divided into 2 groups (20 posts in each group) for different surface treatments. Group 1, treated with silaneafter 35% phosphoric acid; group 2, no surface treatment (Control group). Then each group was randomly divided into 2 minor groups (modified group and traditional group), with each group with 10. So the four groups were group 1M (phosphoric acid + silane-modified), group 1T (phosphoric acid + silane-traditional), group 2M (control-modified), and group 2T (control-traditional). A modified micro-push-out bond strength test method was used in modified groups. In traditional groups, the 20 extracted human, single-rooted teeth were endodontically treated. Gutta-percha was removed with #1-2 Peeso Reamers (Mani), and the post space of each specimen was enlarged with a standard drill system from the corresponding fiber post system to create a 9 mm post space with at least 4 mm of filling material in the root apex. Following post cementation according to the manufacturer's instructions, the traditional micro-push-out bond strengths were tested using a universal testing machine(0.5 mm/min). Both failure modes were examined with a stereomicroscope. The data of the four groups were statistically analyzed using the one-way ANOVA test(α= 0.05). RESULTS: The bond strengths were (18.85±1.42) MPa for group 1M, (19.39±1.35) MPa for group 1T, (11.26±1.57) MPa for group 2M, and (11.27±1.83) MPa for group 2T. The bond strength of Group 1 was significantly higher than that of group 2(P<0.05), no matter which method was used. The fracture mode 100% in group M was the destruction of the post/resin interface, compared with 65.7% in group T. CONCLUSION In contrasted to the traditional micro-push-out test, the modified test can evaluate the bond strength of fiber post to resin cement more effectively, and 35% phosphate acid + silane treatment can improve the bonding strength.
Composite Resins ; Dental Bonding ; Dental Stress Analysis ; Dentin ; Glass ; Humans ; Materials Testing ; Post and Core Technique ; Resin Cements

OBJECTIVE: To compare the effects of three kinds of fiber posts (CAD/CAM one-piece glass fiber posts-and-cores, prefabricated glass fiber post and light curing plastic fiber post) on the bond strength of flared root canals and the effect of thermal cycling on their bond strength. METHODS: Extracted human single teeth (n=90) were endodontically treated and randomly divided into three groups (n = 30 each). The teeth were restored by three kinds of fiber post: CAD/CAM one-piece glass fiber posts-and-cores, prefabricated posts and light curing plastic fiber post. Following post cementation, the specimens were stored in distilled water at 37 °C for 7 days. Half bonded specimens of each group were submitted to thermal cycling (6 000 times, 5 to 55 °C) prior to micro-push-out bond strength test. Fabrication of micro-push-out bond strength test specimens was conducted by precision slicing machine. The micro-push-out bond strength was tested using a universal testing machine, and the failure modes were examined with a stereomicroscope. RESULTS: In CAD/CAM one-piece glass fiber posts-and-cores group, the bond strength of cervical, middle and apical was (9.58±2.67) MPa,(8.62±2.62) MPa,(8.21±2.48) MPa respectively before thermal cycling, and after thermal cycling the bond strength of cervical, middle and apical was (8.14±3.19) MPa,(6.43±2.47) MPa,(6.45±3.20) MPa respectively. In prefabricated posts group, the bonding strength of cervical, middle and apical was (3.89±2.04) MPa,(4.83±1.23) MPa,(4.67±1.86) MPa respectively before thermal cycling, and after thermal cycling the bond strength of cervical, middle and apical was (6.18±1.61) MPa,(5.15±1.94) MPa,(6.39±2.87) MPa respectively. In light curing plastic fiber post group, the bond strength of cervical, middle and apical before thermal cycling was (4.05±2.41) MPa,(1.75±1.70) MPa,(2.60±2.34) MPa respectively, and after thermal cycling the bond strength of cervical, middle and apical was (5.04±2.72) MPa,(1.96±1.70) MPa,(1.34±0.92) MPa respectively. Postal types and root canal regions were found to significantly affect the push-out bond strength. Compared with the other two groups, the one-piece glass fiber posts-and-cores had the highest bonding strength in the cervical, middle and apical. Temperature cycling has no significant effect on the micro push-out bond strength of three kinds of fiber posts. CONCLUSION One-piece glass fiber posts-and-cores has better bonding strength and excellent bonding performance.
Composite Resins ; Dental Bonding ; Dental Pulp Cavity ; Dental Stress Analysis ; Dentin ; Glass ; Humans ; Materials Testing ; Post and Core Technique ; Resin Cements

OBJECTIVE: This study evaluates the effects of different endodontic access methods and full-ceramic crown on the stress distribution in the maxillary central incisor by using three-dimensional finite element analysis. METHODS: Computed tomography scans of the maxillary central incisor were used to construct a three-dimensional finite element model of the maxillary central incisor. According to the different methods of endodontic and the prosthetic treatments, four models were established, namely, group A (traditional access cavity preparation with resin filling), group B (traditional access cavity preparation restored full-ceramic crown), group C (minimally invasive endodontics with resin filling) and group D (minimally invasive endodontics restored full-ceramic crown). A static force of 100 N and a direction of 45° was applied to the long axis of the tooth at the junction of the incisal section one-third and middle section one-third. The maximum principal stress, the von Mises stress and the modified von Mises stress of the tooth tissue were analyzed using the finite-element analysis software. RESULTS: 1) Stress peaks: the stress peaks of the maximum principal stress, the von Mises stress and the modified von Mises in group A were the largest, except that the stress peak of von Mises stress in group D was slightly lower than that in group C. The stress peaks of the maximum principal stress and the modified von Mises in group C were the lowest. The stress peaks of the maximum principal stress and the modi-fied von Mises stress in group D were lower than those in groups A and B. 2) Stress distribution: compared with group A, the stress distribution of cervical dentin and the area of stress concentration in group C was lower and smaller. In the root dentin, the stress distribution in group C was more uniform than that in group A, and the stress was dispersed to several areas of the root apex. After crown restoration, no significant difference was observed in stress distribution between groups B and D in the root region. The stress distribution state of group B was not significantly different from that of group A. No significant difference was observed in the stress distribution state between groups D and C. CONCLUSIONS 1) From the perspective of biomechanics, the minimally invasive access was adopted for the maxillary central incisor. 2) Full crown restoration is recommended after traditional access cavity preparation. No obvious advantage is observed in stress analysis for minimally invasive endodontics-restored full-ceramic crown.
Crowns ; Dental Stress Analysis ; Dentin ; Finite Element Analysis ; Incisor ; Post and Core Technique ; Stress, Mechanical ; Tooth Crown

OBJECTIVE: To evaluate the effect of computer aided design and computer aided manufacture (CAD/CAM) one-piece zirconia posts and cores for the restoration of defective teeth. METHODS: In the study, 72 defective teeth of 47 patients who had proper root canal therapy were restored with CAD/CAM one-piece zirconia posts and cores. All the ceramic crowns were finally used to restore contour and function of the teeth. The defective teeth were divided into two groups on the basis of the teeth defect degree. Group A: 39 defective teeth presented with three or four coronal residual walls, and group B: 33 defective teeth presented with less than two coronal residual walls. During the clinical observation period, the stability, dislocation of posts and the occurrence of fractures in either teeth or posts and cores were assessed and analyzed with a paired t test(α=0.05). Meanwhile shade matching was conducted between the restored teeth and normal reference teeth, the marginal fitness of the restored teeth were recorded according to the standard of United States Public Health Service (USPHS) and analyzed with descriptive statistics. RESULTS: The average follow up was (65.0±4.8) months. During the observation period, the restorations were examined both clinically and with periapical radiograph. No incidence of teeth fracture or posts and cores complications were observed in both groups, and all CAD/CAM one-piece zirconia posts and cores remained intact with restored teeth. There were no post and core dislodgement or fracture. There was no difference between group A and group B (P>0.05). The restorative effect of CAD/CAM one-piece zirconia posts and cores with all the ceramic crowns were assessed according to the standard of USPHS, and the number of the restored tooth shade matching with level A was 67, and 5 with level B. The rate of shade matching was 93.06%. As the marginal fitness, 64 restored teeth were level A, and 8 with level B. The rate of restorative teeth marginal fitness was 88.89%. CONCLUSION CAD/CAM one-piece zirconia posts and cores were successfully used to restore defective teeth and received excellent clinical effect. So, it can be a good choice for defective teeth which need post-cores and crowns restoration.
Computer-Aided Design ; Dental Prosthesis Design ; Dental Restoration Failure ; Follow-Up Studies ; Humans ; Incisor ; Post and Core Technique/instrumentation* ; Prospective Studies ; Tooth Fractures ; Zirconium

OBJECTIVES: This study evaluated smear layer removal by different chemical solutions used with or without ultrasonic activation after post preparation. MATERIALS AND METHODS: Forty-five extracted uniradicular human mandibular premolars with single canals were treated endodontically. The cervical and middle thirds of the fillings were then removed, and the specimens were divided into 9 groups: G1, saline solution (NaCl); G2, 2.5% sodium hypochlorite (NaOCl); G3, 2% chlorhexidine (CHX); G4, 11.5% polyacrylic acid (PAA); G5, 17% ethylenediaminetetraacetic acid (EDTA). For the groups 6, 7, 8, and 9, the same solutions used in the groups 2, 3, 4, and 5 were used, respectively, but activated with ultrasonic activation. Afterwards, the roots were analyzed by a score considering the images obtained from a scanning electron microscope. RESULTS: EDTA achieved the best performance compared with the other solutions evaluated regardless of the irrigation method (p < 0.05). CONCLUSIONS: Ultrasonic activation did not significantly influence smear layer removal.
Bicuspid ; Chlorhexidine ; Edetic Acid ; Humans ; Methods ; Microscopy ; Post and Core Technique ; Smear Layer* ; Sodium Chloride ; Sodium Hypochlorite ; Ultrasonics*

OBJECTIVEThe objective of this paper is to analyze the stress distribution in the deep wedge-shaped defective mandibular first premolars restored with different methods.

METHODSThree-dimensional finite element models of mandibular first premolar with deep wedge-shaped defect were created. The model, which was untreated after root canal treatment, served as the control group. Then, according to different treatment designs, four experimental groups were established as follows: resin filling (A), post restoration after resin filling (B), crown restoration after resin filling (C), and post and crown restoration after resin filling (D). Four different post materials were then chosen for establishing the subgroup models: fiber post (B1, D1), AuPd post (B2, D2), pure Ti post (B3, D3), and CoCr post (B4, D4). A force of 100 N was applied at a 30° angle on the buccal-inclined surface near the top of the buccal cusp. The maximum principal stress and Von Mises stress were investigated using finite element analysis software.

RESULTS1) For the control group, the maximum principal stress and Von Mises stress of the residual dentine were the same as those of the tip of the defect. 2) Compared with the control group, the maximum principal stress and Von Mises stress of groups A, B, C, and D decreased greatly (P<0.05). The maximum principal stress and Von Mises stress of groups C and D with crowns were similar. The maximum principal stress and Von Mises stress of the post-dentine surface of groups B and D with fiber post were less than those in the cast metal post models (P<0.05). 3) The displacement of the buccal cusp of group A was similar to that of the control group (P>0.05) and larger than those in groups B, C, and D (P<0.05).

CONCLUSIONSIt is necessary for deep wedge-shaped defective teeth to be treated with full crowns, but a post is not necessary. If a post is used, fiber post with elastic modulus closer to the dentine is more suitable than metal post.
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OBJECTIVES: To determine the optimal timing for post space preparation of root canals sealed with epoxy resin-based AH Plus sealer in terms of its polymerization and influence on apical leakage. MATERIALS AND METHODS: The epoxy polymerization of AH Plus (Dentsply DeTrey) as a function of time after mixing (8, 24, and 72 hours, and 1 week) was evaluated using Fourier transform infrared (FTIR) spectroscopy and microhardness measurements. The change in the glass transition temperature (Tg ) of the material with time was also investigated using differential scanning calorimetry (DSC). Fifty extracted human single-rooted premolars were filled with gutta-percha and AH Plus, and randomly separated into five groups (n = 10) based on post space preparation timing (immediately after root canal obturation and 8, 24, and 72 hours, and 1 week after root canal obturation). The extent of apical leakage (mm) of the five groups was compared using a dye leakage test. Each dataset was statistically analyzed by one-way analysis of variance and Tukey's post hoc test (α = 0.05). RESULTS: Continuous epoxy polymerization of the material with time was observed. Although the T(g) values of the material gradually increased with time, the specimens presented no clear T(g) value at 1 week after mixing. When the post space was prepared 1 week after root canal obturation, the leakage was significantly higher than in the other groups (p < 0.05), among which there was no significant difference in leakage. CONCLUSIONS: Poor apical seal was detected when post space preparation was delayed until 1 week after root canal obturation.
Bicuspid ; Calorimetry, Differential Scanning ; Dataset ; Dental Pulp Cavity* ; Fourier Analysis ; Glass ; Gutta-Percha ; Humans ; Polymerization ; Polymers ; Post and Core Technique ; Root Canal Obturation ; Root Canal Preparation ; Spectrum Analysis ; Transition Temperature