HPB Bolhuis, PhD and P Pallav, PhD

These pages deal with our view on the restoration of teeth. We have compiled here what has been communicated many times in presentations and articles.

You may read these pages as a translated review of the article:

HPB Bolhuis. Endodontisch behandelde gebitselementen: weefselbehoud en adhesieve opbouw beste optie. Ned Tijdschr Tanheelkd 112(2005): 491-496.

This NtvT article appeared in a special issue on endodontics and therefore it contains a few more relatively ‘endodontical’ remarks, which we have left out here and these web pages have a few more added ‘materials science’ remarks.

Conclusions

Preservation of tooth structure generally defines the best solution.

Composite restorations and cusp-covering partial crowns fit best with this concept. Long-term clinical studies are welcomed to find out which solutions are preferred in which cases. Especially in the molar region, depending on individual factors such as the composition of the saliva, eating, chewing-, and para-functional habits, composite restorations clearly aren’t always adequate.

It’s a pity that many dentists seem to find gold partial crowns a past stage, because combining modern adhesive procedures (resin composite core build-up and cements) with tried and tested materials (e.g. gold) may yield durable restorations with a high quality to price ratio.

If posts must be used, it should be precluded that the build up depends entirely on the bond of the post in the root canal (Stankiewicz and Wilson, 2002). 

Posts should be short and conical, and have E-modules close to that of dentin (e.g. fiberglass, carbon fiber). Short rigid posts (e.g. cast metal, Titanium) increase the risk of fracture of the root (Holmes at el., 1996).

Introduction

Here in Netherlands root canal posts are used with the restoration of some 30% of the teeth were the pulp has been removed (Bruers, 2002).

Leakage caused by disintegration of the cement between post, crown, and dental tissue may occur long before anything is clinically observable at the external margins, in laboratory fatigue loading experiments (Freeman et al., 1998).

A survey of clinical research (Heydecke en Peters, 2002) shows that 13% of crowns on teeth with post cores fail within 6 years, where failure either means separation of the post or fracture of the root. Cast posts and cores scored about equivalent to composite cores with a prefabricated post.