Current options concerning the endodontically-treated teeth restoration with the adhesive approach

Abstract

Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.

In vitro fracture strength and modes of cast post and cores luted with self-adhesive resin-based cement

“…The strong physical interaction between the methacrylates in SA resin-based cement 5 may favor adhesion, creating a monoblock restoration. This seems to increase over time 13 and may favor stress distribution. In a similar setting, Pomini et al 13 demonstrated that the bond strength of CPC luted with SA increased after 6 months of storage, indicating that the biomechanical behavior of CPC luted with SA resin-based cement may improve over time, unlike ZP, which is known for lower compressive strength and high solubility in the oral environment.…”

“…This seems to increase over time 13 and may favor stress distribution. In a similar setting, Pomini et al 13 demonstrated that the bond strength of CPC luted with SA increased after 6 months of storage, indicating that the biomechanical behavior of CPC luted with SA resin-based cement may improve over time, unlike ZP, which is known for lower compressive strength and high solubility in the oral environment. 8 In addition, the amount of coronal remnant may have influenced the number of root fractures because the remnant modifies the root stress distribution pattern.…”

“…Ferrule presence is considered the most important factor affecting FR and post and core rehabilitation survival rates 2,4,13 . Nonetheless, metal-based posts and cores have demonstrated the lowest complication rates, being root fractures the most commonly reported complication 4 .…”

Effect of Fiber Posts on Stress Distribution of Endodontically Treated Upper Premolars: Finite Element Analysis

“…Recently, on the other hand, an increasing number of papers have been advocating the use of direct composite restorations without any post for ETT [ 28 , 29 , 30 , 31 , 32 ], stressing the concept that the purpose of a post should be just to retain the core (whenever required) instead of increasing the intrinsic resistance of the root [ 33 , 34 ]; the introduction of innovative and advanced resin-based restorative materials would probably make such a clinical approach even more reliable. Nowadays, in fact, emerging nanotechnologies and improved nanoscale knowledge allows the characterization and control of materials at the atomic or molecular level on a scale of less than 100 nm [ 35 , 36 ].…”

The Method of Diagnosis and Systematization Defects of Dental Hard Tissues

“…In the available medical literature, we did not find any works devoted to the questions of clear systematization of defects of hard dental tissues. At the present stage of the development of dentistry, the dynamic growth of new knowledge, technologies and materials significantly changed the methods of treating defects of dental hard tissues [9]. In clinical cases where the cavity is located subdingivally, the "Cervical Margin Relocation" (CMR) can be used.…”