|Year : 2015 | Volume
| Issue : 2 | Page : 73-77
Comparative evaluation of the metal post and fiber post in the restoration of the endodontically treated teeth
Roshan Uthappa1, Deepika Mod2, Pranav Kharod2, S Pavitra3, Kavita Ganiger4, Hiral Kharod4
1 Department of Conservative and Endodontics, College of Dental Science and Hospital, Amargadh, Bhavnagar District, Gujarat, India
2 Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital, Amargadh, Bhavnagar District, Gujarat, India
3 Department of Conservative Dentistry and Endodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
4 Department of Periodontics, College of Dental Science and Hospital, Amargadh, Bhavnagar District, Gujarat, India
|Date of Web Publication||20-Jul-2015|
Department of Conservative and Endodontics, College of Dental Science and Hospital, Amargadh, Bhavnagar District, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Post-retained crowns are indicated for endodontically treated teeth (ETT) with severely damaged coronal tissue. There are still controversies for the most suitable choice of restorative material and the placement method that will result in the highest success rate. This clinical study compares the metal post and fiber post ins the restoration of the endodontically treated teeth. Materials and Methods: Forty endodontically treated and indicated for the post and core were selected for the study and divided into 2 groups equally. In, one group patient's teeth were restored by metal post, while other group patient's teeth were treated by fiber post. Comparative evaluation was done on follow-up of the patients on the basis of selected clinical and radiographical criteria. The results were compared using student's t test with the help of IBM SPSS Statistics 20. Results: More number of failures was noted in patients whose teeth restored with the metal post as compared to those of the fiber post, both clinically as well as radiographically. (Student's t test, P < 0.01). Conclusion: From the present study, it was shown that fiber post retained restored teeth has less chances of failure as compared to that of metal post. But the results of the present study should be supported by carrying out study on large scale.
Keywords: Endodontically treated teeth, post and core, post retained crowns
|How to cite this article:|
Uthappa R, Mod D, Kharod P, Pavitra S, Ganiger K, Kharod H. Comparative evaluation of the metal post and fiber post in the restoration of the endodontically treated teeth. J Dent Res Rev 2015;2:73-7
|How to cite this URL:|
Uthappa R, Mod D, Kharod P, Pavitra S, Ganiger K, Kharod H. Comparative evaluation of the metal post and fiber post in the restoration of the endodontically treated teeth. J Dent Res Rev [serial online] 2015 [cited 2020 Mar 29];2:73-7. Available from: http://www.jdrr.org/text.asp?2015/2/2/73/161205
| Introduction|| |
Restoration of the endodontically treated tooth is very important as it has impact on the long-term prognosis of tooth. The root canal treated tooth is mostly associated with the loss of coronal and radicular tooth structure from preexisting restorations, restorative failures, trauma, dental caries, and endodontic access preparation. When a huge amount of the clinical crown has been lost due to damage, it is often impossible to achieve the sufficient anchorage of a restoration in the remaining dentin. This hard tissue tooth structure leads to decreased occlusal load carrying capacity of the root canal treated tooth. Therefore, posts are essentially indicated for the root canal treated teeth to prevent fracture of the remaining tooth structure and to prevent tooth loss. ,
A post provides a suitable way to anchor the restorative material to the tooth. The post is inserted into the root canal of endodontically treated tooth, and thus enables the coronal prosthetic core to be built and retained. 
Occlusal loads on the teeth are produced during all the functions of oral cavity. The average maximum occlusal bite force in human was measured at 569 N in the anterior region and 911 N in the posterior region. These forces are applied as a usual potential cause of the deformations in the dental restorations due to the dimensional changes in lengths or volumes they produce in most of the cases. 
A various post and core systems have been investigated till date for the restoration of the root canal treated tooth. In fact, postfailure and prosthetic failure have been cited as the most common cause of failure in endodontically treated teeth. 
Traditionally, prefabricated posts were made with the metal, which sometimes visible through the structure of endodontically treated teeth commonly in the anterior region. Carbon fiber post are among the many prefabricated fiber post and core systems which were introduced to reduce the failure rate of post-retained restored teeth. In addition, quartz and glass fiber posts embedded in a filled resin matrix have been developed to fulfill esthetic requirement. 
Thus, the present study was done to evaluate comparatively the efficacy of the cast metal post and the glass fiber post.
| Materials and Methods|| |
All the patients indicated for the post and core systems were taken into the study, which were visited during the period of 6 months to the department. Forty root canal treated teeth were taken for the study. The patients of either sex between the age group of 18-25 years, and who fulfilled the selection criteria referred to the Department of Endodontics were included in the present study. After the approval from Ethical Committee Board, the written informed consent was obtained from all the individual patients involved in the study.
- Nonvital or discolored teeth with cervical and middle third crown fracture were included in the study
- Teeth with healthy periodontal status and occlusion with sufficient over jet and over bite were included
- Teeth with complete root formation and without any anatomic variation were selected
- Endodontically treated teeth, patients are willing to give written informed consent and agreeing for regular follow-up were taken into three considerations.
- Patient aged <18 years and more than 25 years
- Teeth with periodontal problems or with the large persistent periapical lesion
- Patients having malocclusion with a deep bite, edge-to-edge bite, and a cross bite.
After clinical and radiological examination and confirmation of eligibility criteria, the selected cases were randomly divided into two groups:
All the treated patients were recalled after an interval of 6 months for clinical and radiological evaluations.
- Group I: Cast metal post group - Twenty teeth were restored with the prefabricated cast metal posts [Figure 1] [Figure 2] [Figure 3]
|Figure 1: Intraoral photograph showing prepared root canal for the post in a maxillary first premolar tooth|
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|Figure 2: Intraoral photograph showing metal post in place in the root canal of maxillary first premolar tooth|
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|Figure 3: Intraoral photograph showing post endodontic restoration of maxillary first premolar tooth|
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- Group II: Glass fiber post group - Twenty root canal treated teeth were restored with the prefabricated glass fiber posts [Figure 4] [Figure 5] [Figure 6].
|Figure 4: Intraoral photograph showing prepared root canal for the post in a mandibular first molar tooth|
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|Figure 5: Intraoral photograph showing fiber post in place in the root canal of mandibular first molar tooth|
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|Figure 6: Intraoral photograph showing post endodontic restoration of mandibular first molar tooth|
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The clinical parameters of evaluation were debonding at the post/core and the tooth inter phase (marginal integrity), the mobility of the tooth, crown fracture, and periodontal status. The radiological evaluation parameters were root fracture, crown fracture, periapical status, and adaptation of the posts in the root canal.
The results were calculated and analyzed with the help of IBM SPSS Statistics 20 (IBM Inc., Chicago, USA), using Student's t-test.
| Results|| |
The study was consisted of 40 root canal treated teeth, out of which 20 were treated with the metal post and 20 with the fiber post. It consists of 11 incisor, 03 canine, 23 premolars, and 03 molar teeth [Table 1].
|Table 1: Distribution of the patients according to the tooth type restored |
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When the clinical evaluation was done, 02 patients treated with metal post showed loss of marginal integrity, 03 showed mobility of the crown, and 02 showed crown fracture. While none of the patients with fiber post showed loss of marginal integrity and crown fracture, and only 01 patient showed mobility of the crown. No patients in either case showed symptoms of the periapical pathology [Table 2].
On the radiographical evaluation, 02 patients showed root fracture, crown fracture, and improper adaptation of post in the canal in patients treated by metal post, while no failure were seen radiographically in patients treated by fiber post, except 01 patient showed improper adaptation of the post in the canal [Table 3].
On the comparative evaluation, the metal post showed more number of defects than the fiber post systems [Student's t-test, P < 0.01, [Table 4].
|Table 4: Comparison of the defects of the posts by using Student's t-test |
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| Discussion|| |
In the present study, marginal integrity was lost in 02 patients treated with metal post and no patients treated with fiber post showed loss of marginal integrity. These results of our study were in accordance to the study done by Gbadebo et al.,  in which also 01 patient treated with metal post showed loss of marginal integrity; but in contrast, no such failures were seen in both patients treated by metal post and fiber post in study done by Preethi and Kala. 
On comparing the mobility of the teeth after follow-up of the posttreatment, 03 patients with metal post and 01 patient with fiber post showed posttreatment mobility of the crown. These results were similar to study done by Preethi and Kala  and Gbadebo et al.,  in both which 01 patients of metal post showed mobility of the teeth, while no patients with fiber post showed mobility of the teeth in study by Preethi and Kala  and 01 patient showed tooth mobility in study by Gbadebo et al. 
The incidence of crown fracture was also evaluated clinically on follow-up of the patient and 02 patients of metal post showed fracture of the crown, while none of the patients treated with fiber post showed fracture of the crown. These results were in contrast to the study done by Gbadebo et al.  and Preethi and Kala;  in which no patients showed incidence of the crown fracture. No patients treated with the post showed evidence clinical symptoms of the periapical pathology.
The patients were also evaluated radiologically for the success of posttreatment. When the fracture of the tooth was evaluated radiographically, 02 patients treated with metal post and no patient with fiber post showed root fracture, while 02 patients treated with metal post showed crown fracture and none of the patient treated with fiber post showed crown fracture. Only 02 and 01 patients of the metal post and fiber post, respectively, showed improper adaptation of the post in the root canal.
Thus, according to our study metal post showed more number of failures as compared to fiber post. These results were in accordance to the study by Shashikala and Sharma,  Preethi and Kala,  and Gbadebo et al. 
Endodontic posts have been classified into various ways such as the preformed and custom cast, metallic and nonmetallic, stiff and flexible, esthetic and nonesthetic. 4-8 posts are usually required for supporting a core foundation, when there is insufficient clinical tooth structure remaining.  The choice of post design must be in accordance with the biomechanical requirements of the remaining tooth structure.  One of the major functions of a post and core systems are to improve the resistance to laterally directed forces by distributing them over as large area as possible. 
When two or more different components are placed in close contact with one another, the components and interfaces created will be subjected to considerable clinical and functional demands and forces. Components with higher elastic-modulus (cast post/core) will transfer functional stresses to the lower elastic-modulus components, that is, dentin and ultimately result in endodontic or restorative failures. When all components in contact have similar elastic-moduli there is more uniform stress distribution and lowered interfacial stress and failure. This phenomenon has been coined by "monobloc." "Monobloc" requires that, all components of a tooth restoration have similar elastic-moduli to dentin and to allow the components to move, flex, and stresses one assembly. This phenomenon is incorporated in fiber posts. ,,
Accumulation of metallic corrosion by-products also weakens the dentin and the interface between the post and the prepared canal. The newer fiber-reinforced post systems preserve tooth structures are noncorroding, and have a similar elastic-modulus compared to dentin making them more compatible than their metal counterparts. 
The retention of metal posts are affected by post surface area, shape, and type of cement used. Parallel posts need more tooth structure to be removed. Tapered and cemented posts need retentive characteristics (grooves, threads) for sufficient retention. Bonding is used instead of cementing in the newer post systems (fiber-reinforced) for increased retention. 
Fiber posts are ready to use whereas more time, extra clinic and laboratory time are required for the metal post.  One of the main clinical advantages of the fiber-reinforced post is the ability to remove them easily and without trauma. Fiber posts are not retrieved in one piece like a cast or prefabricated post, but are removed from the canal by drilling down directly through them. Metal post systems have a much higher potential for causing adverse biologic effects and allergic reactions. Quartz-glass fiber posts have a lower allergenic potential, and are generally considered to be more biocompatible. 
The reasons for the failures of the post root canal restorations mostly are root fracture, microleakage, metal corrosion, decementation, and concentration of the forces. 
The use of these glass fiber posts has advantages such as better biocompatibility, more rapid treatment, esthetics, and corrosion resistance. Moreover, it has been reported that when compared with the traditional metallic cast posts, glass fiber posts decrease the likelihood of irreparable root fractures. 
| Conclusion|| |
From the present study, it is shown that the fiber post retained crown restoration had lesser chances of failures as compared to a metal post. However, the results of the present study should be supported by doing this type of study on a large scale.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4]