Академический Документы
Профессиональный Документы
Культура Документы
INDEX WORDS: endodontically treated teeth, posts and cores, incidence data
a.
requiring endodontic treatment has varied in different studies. The results have been: 3% after 5 years?
3% after 10 years,&6% after 2 to 6 years: 10% after
10 years: 14% after 7 year^,^ and 21% after 6 years.8
The gencrally higher incidence with fixed partial
dentures is assumed to he related to the greater
tooth reduction required to align multiple teeth and
perhaps also related to the grcater occlusal forces on
some types of prostheses. These assumptions are
supported by Raridow et algwho reported an increasing incidence related to the size of thc prosthesis: 7%
for 7-unit prostheses, 9% for %unit prostheses, and
23% for 10-unit prostheses.
Reuter and BroscIo found a difference between
abutments with little or no caries at the time of tooth
preparation and abutments with deep carious lesions. Three percent of the teeth with little or no
caries required endodontic treatment after 5 years,
whereas 10% of the teeth with deep carious lesions
required treatment. Bergenholtz and Nymanll reported on thc need for endodontic treatment in
patients with advanced periodontal disease who reccivcd both periodontal and prosthodontic treatments. Three percent of the periodontally treated
teeth that were not prepared for fixed prostheses
required endodontic therapy 4 to 13 years after
treatment, whereas 15%of the periodontally treated
teeth that were prepared for fixed prostheses needed
endodontic treatment. There was an increase in the
need for endodontic therapy when the bone loss
exceeded one third of the root length. They also
noted that 50% of the pulpal problems occurred 7 to
243
244
Goodacreand Sfilnik
Summary
The incidence of endodontic treatment required
after tooth preparation has ranged from 3% to 23%.
Fixed partial dentures and complex prostheses had
higher incidence rates than single crowns. It has been
assumed that the higher rates are because of the
greater tooth reduction sometimes required to align
multiple teeth. The incidence is higher when the
prepared teeth have deep carious lesions and when
horns ofboth central incisors at the time of tooth preparation. Provisional resin crowns were cemented, and 3 weeks
later, dark areas (arrows) are noted where the pulpal
blush had occurred. The authors experience indicates
serious pulpal stress has occurred when dark areas are
noted after a pulpal blush. Teeth with stressed pulps
should be treated before complex prosthodontic treatment
is completed.
Need Crowns?
245
Summary
Crowns should generally be used on endodontically
treated posterior teeth but are not necessary on
relatively sound anterior teeth.
Do Posts Reinforce
Endodontically Treated Teeth?
246
Summay
The primary purpose of a post is to retain a core that
can be used to retain the definitive prosthesis. Posts
do not reinforce endodontically treatcd teeth and are
not necessary when substantial tooth structure is
present after teeth have been prepared (Fig 4). A
post and core may help prevent coronal fractures
when the remaining coronal tooth structure is very
thin after tooth preparation (Figs 5 and 6).
Go:oodacreand Spolnik
247
Summary
Summary
Although there are many types of post and core
failures, loosening of the post and tooth fractures
were two of the most common occurrences. Three
papers reported that post loosening occurred more
often than tooth fractures. Two studies found slightly
higher incidences of tooth fracture than post loosening, and one study found comparable incidences of
post loosening and tooth fracture.
24 8
Summay
Three percent to ten pcrccnt of post and corc failures
are attributable to root fractures (Fig 8). Threaded
post forms are the most likely to cause root fracture
and split, and threaded flexible posts do not reduce
stress concentration during function. Cemented posts
produce the least root stress.
summary
Although there are several laboratory studies and
some clinical data that indicates that parallel-sided
posts are less likely to cause root fracture, other
clinical studies have shown good success with tapered
posts. It seems that additional clinical studies of a
prospective nature are required to resolve this issue.
References
1. .Jones GlynJC: The success rate of anterior crowns. Br DentJ
1972;132:399-403
2. Cheung G S P A preliminary investigation into thr longevity
and causes of failure of single unit extracoronal restorations.J
Dent 199I ; 19: 160-163
3. Schwartz NL., Whitsett LD, Berry TG, et al: Unserviceable
crowns and fixed partial dentures: Life-span and causes for
loss ofserviceability.JAm Dent Assoc 1970;81:1395-1401
4. WaltonJN, Gardner F M ,AgarJR: A survey of crown and fixed
partial denture failures: Length of service and reasons for
replacement.J Prosthet Dent 1986;56:416-421
5. Jackson CR, Skidmore AE, Rice RT: Pulpal evaluation of teeth
restored with fixed prostheses. .J Prosthet Dcnt 1992;67:323-
325
6. Karlsson S: A clinical evalnatiori of fixed bridges, 10 years
following insertion. J Oral Rehab 1986;13:423-432
7. Glantz POJ: The clinical longevity o f crown and bridge
prosthescs, inhusavice KJ (ed): Quality Evaluation nfDental
Restorations: Criteria for Placement and Replacemrnt: Proceedings of the International Symposiunl on Criteria for
Placement of Dental Restorations. Chicago, IL, Quintessencc,
1989, pp 343-354
8. Foster L V Failed conventional bridge work Iiom general
dental practice: Clinical aspects and treatment needs of 142
cases. BrDentJ 1990;168:199-201
9. Randow K, Glantz PO, Ziiger B: Technical failures and some
related clinical complications in extensive fixed prosthodontics. Acta Odontol Scand 1986;44:241-255
10. ReuterJE, Brosc MO: Failures in full crown retained dental
bridges. Br DentJ 1984;157:61-63
249
periodontal and prosthetic treatment of patients with advanced periodontal diseasc.J Periodontal l984;55:63-68
12. A h - R a s s hil: The stressed piilp condition: An endodonticrestorative diagnostic concept. J Prosthet Dent 1982;48:264-
267
13. Sorensen .JA, Martinoff JT: Intracoronal reinforcement and
coronal coverage: A study of endodontically treated teeth. J
Prosthet Dent 19845I :780-784
14. Gutmann J L The dentin-root complex: Anatomic and biologic considerations in restoring rndodontically treated teeth.
.J Prosthet Dent 1992;67:4581167
15. Helfer AR, Melnick S, Schildrr 1%:Determination of the
moisture content of vital and pulpless tccth. Oral Surg
1972;34661-670
16. Reeh ES, Messer HH, Douglas hW Reduction in tooth
stiffness as a result of endodontic and restorative procedures.,J
Endodont 1989;15312-5 16
17. 'I'idmarsh BG: Restoration of endodontically trcated posterior
teeth.J Endodont 1976;2:374-375
18. Grimaldi J: hlcasurement of the lateral deformation of the
tooth crown under axial compressive cuspal loading. Thesis,
University of Otago, Dunedin, New Zealand, 1971
19. Carter Jhf, Sorensen SE, Johnson RR, et al: Punch shear
testing of extracted vital and endodontically treated teeth. J
Biomech 1983;16:841-848
20. Rivera E, Yamauchi C, Chandler G, et al: Dentin collagen
cross-links of root-filled and normal teeth (Abstract).J Endodont 1988;14:195
21. Lovdahl PE, Nicholls .TI: Pin-rctained amalgam cores vs.
cast-gold dowel-c0res.J Prosthet Dent 1977;38:507-514
22. 1.11 YC: A comparative study of fracture resistance of pulpless
tccth. ChinUentJ 1987;6:26-31
23. Guzy GE, Nicholls,JI:In vitro comparison o f intact endodontically trcated teeth with and without endo-post reinforcement.
J Prosthct Dent 1979;42:39-U
24. Leary JM, Aquilino SA, Svare C W An evaluation of post
length within the elastic limits of dentin. J Prosthet Dent
198:;57:277-28 I
25. Trope 11,Malt/: DO, Tronstad L Rrsistance to fracture of
restored endodontically treated teeth. Endodont Dent Traurnalol 1985;1:108-111
250