Purpose: The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth. Materials and Methods: A MEDLINE, a Cochrane, and an EMBASE search (three specified searches) were conducted to identify randomized (RCT) and nonrandomized controlled clinical trials (CCT), cohort (CS), and case control studies (CCS) until January 2008, conducted on humans, and published in English, German, and French, relating to dowel and core systems for restoring endodontically treated teeth. Also, a hand search was conducted, along with contact with the authors when needed. Results: The MEDLINE, Cochrane, and EMBASE searches identified 997, 141, and 25 published articles, respectively. Ten articles from the MEDLINE and seven articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. Six out of the ten studies were RCTs, two were CCTs, and two CSs. The RCT studies suggest that carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (number needed to treat, NNT = 8.30). Tapered gold alloy cast dowels are better than ParaPost R gold alloy cast dowels (NNT = 13.15). ParaPost R prefabricated dowels are slightly better than ParaPost R cast dowels (NNT = 175.4). Glass fiber dowels are significantly better than metal screw dowels (NNT = 5.46), but worse than titanium (NNT = −21.73) (moderately). Carbon fiber dowels are worse than gold alloy cast dowels (significantly) (NNT = −5.81) and than amalgam dowels (NNT = −125) (slightly). The CCT studies suggest that metal dowels are better (NNT = 21.73) but also worse than cast dowels (NNT = −33.33) depending on the remaining amount of coronal hard tissue. Quartz fiber dowels show success rates similar to and worse than glass fiber-reinforced dowels (NNT = −37.03). The results from the CS studies suggest that carbon fiber in resin matrix dowels are better (moderately) than carbon fiber + quartz and quartz fiber dowels. Titanium dowels with a composite build-up are better (moderately) than gold alloy cast dowels. Conclusions: According to the studies of the highest levels of evidence, carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (RCT). Glass fiber dowels are significantly better than metal screw dowels (RCT) and moderately better than quartz fiber dowels (CCT). Carbon fiber dowels are significantly worse than metal dowels (of precious alloy) (RCT). Prefabricated metal dowels are slightly better than cast dowels (RCT), but moderately worse when no collar of the dentin above the gingiva could be achieved (CCT).The purpose of this study was to compare different dowel and core materials based on the available clinical trials of the highest level of evidence. The analysis was limited to levels 1 to 3 of clinical evidence, because these levels are able to demonstrate causality. Controlled clinical trials, randomized or not (level 1), cohor...

For the highest level of evidence (RCT) retrograde (root-end)-filling with glass ionomer cement is almost as effective as amalgam. However, there was a significant caveat as there were only two RCTs. At the next highest level of evidence (CCT), and given the additional caveat that there was only one controlled trial for each material, retrograde (root-end) EBA cement, composite with Gluma and gold leaf, as well as orthograde gutta-percha, may be more effective than retrograde (root-end) amalgam filling. In conclusion, these results suggest that additional validating CCTs and RCTs are needed.

The purpose of this review was two-fold: (a) to determine which retrograde obturation material(s) best prevents dye/ink penetration in vitro; and (b) to determine whether in vitro results agree with in vivo results. A MEDLINE search was conducted to identify in vitro studies published between January 1966 and October, week 4, 2003, conducted on human teeth, and published in English, German, or French language, testing the resistance to retrograde penetration of retrograde filling materials. The MEDLINE search identified 278 published articles. Of those, 115 studies examined the resistance to penetration of various retrograde filling materials, in vitro. Thirty-four studies met all the inclusion and validity criteria. The results indicate that, beyond 10 days in vitro, the most effective retrofilling materials, when measured by dye/ink penetration are: composites>glass ionomer cement>amalgam>orthograde gutta-percha>EBA. The results of these in vitro studies are not congruent with in vivo study results, suggesting a need to re-evaluate the clinical validity and importance of in vitro studies.

Purpose: The aim of this systematic review was to answer the question "Which treatment protocol, among classical methods and/or various laser applications is the most effective in root canal disinfection, in vitro". Materials and Methods: A MEDLINE, a Cochrane and an Embase search (three specified searches) were conducted to identify randomized controlled trials (RCT) until June 2010, conducted on human teeth and published in English, German or French language, examining the root canal disinfection after the use of lasers with or without mechanical instrumentation. Additionally, hand search was conducted and contact with authors, when needed. Results: The MEDLINE, the Cochrane and the EMBASE search identified 240, 28, and 35 published articles, respectively. Ten articles from the MEDLINE and 5 articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. In E. faecalis elimination, instrumentation of the root canal and diode laser/665 nanometer/1 Watt (diode laser/665 nm/1 W) irradiation with the combined effect of Methylene Blue (MB) as photosensitizing agent (logCFU/ml = 1.636) seemed to be the best method. In P. aeruginosa and in A. naeslundii elimination, instrumentation of the root canal followed by irrigation with 5.5% NaOCl (log-CFU/ml = 0) seemed to be the best method. In general, instrumentation of the root canal followed by irrigation with 5.25% NaOCl (logCFU/ml = 0) and instrumentation of the root canal and Er: YAG laser/ 2940 nm/0.8 W irradiation (logCFU/ml = 1.924) seemed to be the best (polymicrobial studies). Conclusions: There are treatment protocols with the assistance or not of laser irradiation that can eliminate E. faecalis, E. coli and S. aureus inside the root canal. However, there is a serious number of S. anginosus, F. nuclea-tum, A. naeslundii and P. aeruginosa that remain inside the root canal even after laser irradiation. New research is needed in order to set a treatment protocol effective in the root canal disinfection from all bacteria that are related to endodontic origin pathology.