RESEARCH SUMMARY

Summary of:
A comparison of the survival
of bre posts cemented with
two different composite
resin systems
S. B. Mehta
1
and B. J. Millar
2
VERIFIABLE CPD PAPER
EDITOR'S SUMMARY
In clinical practice as well as in the arena
of research studies one fact comes through
as strikingly obvious: that nothing we
are able to provide as clinicians matches
up to that with which nature endows us.
The conuence of materials, techniques
and altered biological tissues often seems
to conspire to confound our best efforts
to restore damaged hard tissues.
Thus it is that as we make gradual
progress in moving from metal posts as
a foundation to restore endodontically
treated teeth, we also need to take account
of the cements that we use to secure the
bre resin equivalants. This study pro-
vides some valuable information on the
comparison of the medium-term suc-
cess of two luting agents, indicating that
the choice of material can inuence the
prognostic outcome. What the study also
highlights is the number of other factors
that have to be considered not only in
the meaningful study of the subject but
also in contemplating the clinical situa-
tion. The causes of failure were associ-
ated with root fracture, decementation,
fracture at the post-core interface, end-
odontic failure and marginal caries. In
addition, signicantly higher failure
rates were observed to occur in partially
dentate patients, in those with parafunc-
tional habits and also amongst ante-
rior teeth. A plethora of considerations
around which to negotiate.
We would all like to be able to see into
the future and predict which treatments
work best for longest. Sadly we cannot
and our next best tool in this respect
has to be research and extrapolation.
The authors have provided us with some
valuable indicators to guide our daily
decision making based on observation,
careful analysis and best practice. Only
with the benet of hindsight will we
know with greater surety which method
stood the test of time and function, in
the interim we can reassure our patients
that we are doing the best we can on the
evidence we have.
The full paper can be accessed from
the BDJ website (www.bdj.co.uk), under
Research in the table of contents for
Volume 205 issue 11.
Stephen Hancocks,
Editor-in-Chief
DOI: 10.1038/sj.bdj.2008.1036
FULL PAPER DETAILS
1
General Dental Practitioner/Part-time Clinical
Teacher,
2*
Senior Lecturer/Consultant in Restorative
Dentistry and Director of Distance Learning,
Department of Primary Dental Care, Kings
College London Dental Institute at Guys, Kings
College & St. Thomas Hospitals, Caldecot Road,
London, SE5 9RW
*Correspondence to: Dr Brian J. Millar
Email: [email protected]
Online article number E23
Refereed Paper - accepted 20 August 2008
DOI: 10.1038/sj.bdj.2008.1023

British Dental Journal 2008; 205: E23

600 BRITISH DENTAL JOURNAL VOLUME 205 NO. 11 DEC 13 2008
Objectives To evaluate the outcomes of a bre post cemented with two different luting agents. Methods A single type of
tooth coloured bre post (Fibre-White Parapost, Coltene Whaledent) was used along with two different types of luting ce-
ment. A total of 129 teeth were treated in this retrospective audit: 79 treated were luted with Calibra Aesthetic Dental Res-
in Cement (Dentsply) and 50 with Panavia F 2.0 (Kuraray). All teeth were treated by the same operator and had a minimum
ferrule of 2 mm and a ParaCore (Coltene Whaledent) composite core placed over the post. Where Calibra Aesthetic Dental
Resin Cement was used, all the restorations were undertaken between June 2002 and October 2003 and were reviewed
for a period of 38 to 54 months. Where Panavia had been used, all restorations were placed between February 2004 and
December 2005 and reviewed for a period of 28 to 50 months. Results The results for the Calibra cemented posts were: 64
returned for recall and of these 23 were classed as failed. The causes were: root fracture (2), decementation (3), fracture at
post-core interface (6), endodontic failure (8) and marginal caries (4). The results for the Panavia cemented posts were: 44
returned for recall and 9 were classed as failed; the causes of failure were fracture at post-core interface (6), endodontic
failure (1) and marginal caries (2). Conclusions For posts cemented with Calibra, a success rate of 64.1% was determined
over a period of 38 to 54 months. The use of Panavia resulted in fewer post failures with a reported success rate of 79.5%
over an evaluation period of 28 to 50 months. Mechanical failures by means of fractures occurring anywhere along the
length of the post-core complex were the major cause of lack of success. Signicantly higher failure rates were observed
to occur in partially dentate patients, in those with parafunctional habits and also amongst anterior teeth. While the ma-
jority of the mechanical failures were amenable to repair, the latter mode of failure appears to be a major downfall when
considering the routine use of bre resin posts in restorative dentistry. The choice of cement appears to have a signicant
role in improving prognostic outcome.
2008 Macmillan Publishers Limited. All rights reserved.

COMMENT
Use of tooth coloured bre posts is
increasing but their clinical perform-
ance has been less extensively studied
than use of metal posts. This study will,
therefore, prove of interest to readers of
the British Dental Journal. The signi-
cance of the choice of the two post lut-
ing agents is that one (Panavia F.2.0)
has potential to chemically bond to the
post while the other (Calibra) may not.
A limitation of the study, fully admit-
ted by the authors, is that it is a retro-
spective audit. Thus the review periods
varied for each material and between
materials, the time of placement using
the two luting materials was consecu-
tive rather than concurrent and the
status of the dentition was not stand-
ardised, which could have impacted
on the outcomes, as could the lack of
standardisation of the distribution of
groups of teeth in which posts were
placed and the differences in sample
sizes of the two groups evaluated.
The great strengths of the study,
however, are that all posts and sub-
sequent procedures were undertaken
using a standardised technique and
following manufacturers instruc-
tions, by the same operator in the
same general (private) practice. Unfor-
tunately, again due to the nature of
the audit, the assessment of failure
or otherwise of the procedures was
made by the operator and not a trained
independent observer.
Correctly, in view of the nature of
this study, no statistical analyses were
attempted. Instead, descriptive statis-
tics are provided. The relatively high
rate of fracture at the post/core inter-
face identied in the study is of con-
cern and is consistent with in vitro test
results. The relatively low level of root
fracture is consistent with in vivo stud-
ies and is a potential advantage over
metal post systems.
While no rm conclusions can be
drawn with regard to the choice of lut-
ing material, valuable areas for further
studies are highlighted.
S. Dunne, Head of Department
of Primary Dental Care,
Kings College London Dental Institute
1. Why did you undertake this research?
Fibre resin posts (FRPs) have been devel-
oped to provide more aesthetic, biocom-
patible, retrievable and conservative
alternatives to their traditional metallic
endodontic post counterparts. Addition-
ally, it has been postulated that FRPs, on
account of their mechanical properties,
would overcome the well documented
problem of root fracture frequently
associated with the use of metal posts.
To date, there have been relatively few
clinical studies undertaken to assess the
performance of FRPs and very little is
known about the inuence of the type
of resin lute used to place FRPs within
the post canal. The purpose of this audit
was to gain further information relevant
to everyday restorative dental practice.
The audit was undertaken as part of the
fullment of a post-graduate degree.
2. What would you like to do next in this
area to follow on from this work?
Of what little data is available on the
clinical outlook of endodontically treated
teeth restored by means of bre resin
post systems, much is short- to medium-
term in duration. The undertaking of a
10 year survival assessment would pro-
vide much sought after information on
the long-term performance of such post
systems. It would also be interesting to
evaluate the effect on clinical survival
with the use of bre resin posts of dif-
fering chemical, mechanical and physi-
cal properties, as would be the impact
of the inuence of differing types of
resin lute, in particular the new genera-
tion of smart cements (7th generation
bonding agents).
RESEARCH SUMMARY
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follow the step by step guide.
Describes the results of 3-5 year audit
on bre resin posts used to restore
endodontically treated teeth with the use
of two differing resin luting agents.
Highlights the importance of the
appropriate choice of resin lute.
Suggests that root fractures are seldom
encountered with the use of FRPs but
fractures occurring along the post-core
interface appear to be a cause for concern.
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BRITISH DENTAL JOURNAL VOLUME 205 NO. 11 DEC 13 2008 601
2008 Macmillan Publishers Limited. All rights reserved.