Association between intra-radicular posts and periapical lesions in endodontically treated teeth

Abstract

Introduction:A significant number of endodontically treated teeth restored with posts have associated periapical lesions, and several authors have discussed the probable causes of the development of these. Attention has been focused on restorative procedures performed after endodontic treatment and their association with the prognosis of endodontic therapy because a number of root-filled teeth will require post- and core-retained restorations.Purpose:The purpose of this study was to evaluate, by examination of periapical radiographs, whether the placement of intra-radicular posts in endodontically treated teeth may act as a risk factor for development of periapical lesions.Material and Methods:This case-control study analyzed periapical radiographs of 72 endodontically treated teeth with coronal restorations. All radiographs were obtained from a single private practice. Specimens were assigned to 2 groups: Group 1 (control) was composed of teeth without periapical lesions and Group 2 (case) was composed of teeth with periapical lesions. The number of teeth with and without posts in each group was recorded. Three calibrated examiners analyzed the radiographs visually under X4 magnification.Results:In Group 1, 28 (65.1%) out of 43 teeth were restored with posts. In Group 2, 24 (82.8%) out of 29 teeth had intra-radicular posts. The interpretation of chi-square test showed that these percentages were not significantly different (x2=2.687; p=0.101). Odds ratio was 2.571 (0.8158.118), which indicates that there was no statistically significant association between periapical lesions and posts.Conclusion:Intra-radicular posts placed in endodontically treated teeth were not a significant risk factor for development of periapical lesions in the practice where the cohort of patients was treated.

Radiographic analysis of 1000 cast posts in Sergipe state, Brazil

“…With the evolution of dental materials and the implementation of adhesive systems, many changes have occurred in dental specialties, and despite the growing use of prefabricated posts 1 , cast metal posts and cores are still widely used 3,5,6,12,17 , and their situation requires assessment.…”

“…Presence of periapical lesion is a criterion that generates doubts 7,17,18,20,21 , considering that without the initial control of treatment, it is impossible to know whether the existing lesion has regressed, developed, or remained stationary. Hommez et al 18 and Durighetto et al 5 concluded that the presence of a post in the root canal has no influence on apical health.…”

“…The following prosthetic data were considered satisfactory: cast metal posts and cores with post length equal to 2/3 of root length (1mm error margin); post diameter equal to 1/3 of root diameter (0.5mm error margin); post:bone crest ratio with the post reaching 1/2 of root bony implantation; post contiguous to root canal with no deviations; absence of gap between post and the remaining root canal filling (0.2mm error margin); remaining root canal filling in the apical third of the tooth, with a minimum of 4mm of guta percha (below 4mm was considered inadequate and above 4mm was considered adequate, as long as not combined with short posts); and absence of periapical lesion (Figure 1). The radiography viewer was calibrated according to the criteria evaluated, which were selected based on the methodology of previous studies and according to the standards described in the specific scientific literature 2,3,[5][6][7][8][9]11,[17][18][19][20][21] .…”

“…Although the cast metal post-and-core system can present failures, it is still widely used with indication for elements with little dental remnant and for support of prosthetic restorations and posterior teeth 3,5,6,12,17 .…”

“…In view of the need for root retention, much is discussed about endodontic treatment being compromised after restoration using this system 17 , as well as with respect to maintenance, or emergence of periapical lesion 5,7,[17][18][19][20] . It is believed that a well-performed endodontic treatment leads to greater care in the execution of prosthesis, reinforcing that this is a basic criterion for the beginning of the prosthetic stage preparation, in such a way that these two stages are inseparable and must be conducted properly to obtain success 5,6 .…”