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*Corresponding Author: Abdulwahab Ismail Al-kholani, Dean of Faculty of Dentistry on 21 September University, Yemen, Head of Restorative and Esthetic Dentistry Department, Dental Implant Consultant.
Citation: Anhar A. Issa, Al-Shameri BH, Mohsen Ali Al-Hamzi, Abdulwahab Ismail Al-Kholani, Al-Kinani MA, et al, (2024), Radiological Analysis of Post Quality in Post Crown Restoration among a Sample of Population in Sana'a City, J Clinical Research and Reports, 17(2); DOI:10.31579/2690-1919/414
Copyright: © 2024, Abdulwahab Ismail Al-kholani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 23 September 2024 | Accepted: 04 November 2024 | Published: 27 November 2024
Keywords: post and core; post length; post width; post shape; gutta-percha length; digital periapical image
Introduction: Endodontically treated teeth require restoration to ensure long-term survival and function. Proper post-space preparation is crucial for successful restoration.
Material and Methods: A retrospective study was conducted using digital periapical radiographs of endodontically treated teeth (ETT) restored with posts in Sana'a City. Three hundred and fifty-two radiographs were included in the analysis. The following information was extracted from each image: Tooth characteristics: Type, number, and jaw involvement. Post characteristics: Shape, length about root and crown length, width about root width, and length in bone. Gutta-percha (GP) characteristics: Presence of space between GP and post, length of remaining GP in canals, and extension beyond root apices. Root canal treatment quality: Overall assessment. Statistical analysis was performed using SPSS. Descriptive statistics were generated, and the association between different variables was evaluated using the chi-square test at a significance level of p < 0.05.
Result: Posts were used to restore maxillary and mandibular teeth equally (49.7%, 50.3%). Prefabricated parallel metal posts were the most used (58%), followed by posts placed in premolars (41.2%). Adherence to prosthetic guidelines was poor. Only 25.3% of posts had a width equal to one-third of the root width. Post length was rarely two-thirds of the root length (5.1%), and often exceeded crown height (61.9%). In 73.6% of cases, there was no space between the gutta-percha (GP) and the post. The remaining GP length was 3–5 mm in 27.9% of cases. These findings highlight the need for improved adherence to prosthetic guidelines in endodontic treatment.
Conclusion: To enhance the quality of post-crown restorations, dentistry schools, and private clinics should implement a controlled academic supervisory environment and a rigorous scientific approach to fixed prosthodontics. This would ensure that radiographically evaluated restorations meet the highest standards of care.
Restoring endodontically treated teeth (ETT) is crucial for long-term success and survival of the teeth 1. To successfully restore ETT, the surviving tooth must be protected, the coronal seal must be effective, the function must be restored, and the aesthetics must be acceptable.2
Nowadays dental clinicians understand “The naturally retained root is the ultimate dental implant”. The ETT with extensive loss of tooth substance have multiple problems due to significant reduction in the capability to resist a myriad of functional forces 2.
Fracture is one of the major incidences encountered in ETT. It was found that the risk of fracture of ETT is 3 to 4 times more than vital teeth3. The fracture resistance of ETT has been reported to be principally dependent on the amount of the remaining tooth structure, the amount of adhesive surface, and the quality of adhesion 4.
When endodontic treatment is conducted on compromised teeth whether badly decayed, heavily restored, or fractured, the mechanical integrity is affected. Access cavity preparation, dentin removal for standard endodontic treatment procedures, and optimal preparation for subsequent restorative treatment can influence the mechanical integrity of the tooth. To repay for such weakness, different materials and techniques have been introduced in terms of modern principles of post and core utilization 5.
Post and core systems are mostly used to restore ETT with extensive loss of structure 6. A post is indicated when there is inadequate remaining coronal tooth structure to retain a core to ensure the success of the future indirect restoration 7. Posts can protect teeth from fracture by dissipating or distributing forces along the tooth 8. Posts are also indicated to intensify the retention of the amalgam and composite core. However, not all ETT require a post 9, and since posts do not reinforce such teeth 10 their use have to be limited to those with inadequate tooth structure. In addition, preparing space for the post is associated with some risk 9. Even rare, the risk includes perforation in the apical portion of the root or into the lateral fluted areas of the mid-root, called “strip perforation” 11. The causes for the failures of the post root canal restorations mostly are root fracture, microleakage, metal corrosion, decementation, and concentration of the forces 12.
The most common types of fractures in post-retained restorations are root fracture, loosening of the post and fracture of the post 13. Root fractures are most frequently unrestorable, which subsequently results in the extraction of tooth 13.
A numerous post and core systems have been investigated till date for the restoration of the root canal treated tooth. In fact, post failure and prosthetic failure have been cited as the most common cause of failure in ETT 14.The ETT supported with post and core was considered as a regular procedure in dental practice. Many criteria have been suggested to assess the quality of post and core restorations. Most of these criteria are dependent mainly on radiographic evaluation alone or in combination with clinical examination 15.
The outcomes of post and core restorations in the prosthetic treatment plan depend on the success of every treatment phase. Hence, radiographic assessment must be performed as follows: Before post insertion to check of root canal treatment system seal, after cementation, during follow-up after teeth exposure to masticatory loading forces, and monitoring during maintenance recall to evaluate the treatment method according to data supplied by specialized literature references 16.
This cross-sectional study was conducted in Sana'a, Yemen, and was approved by the Research Ethics Committee of the Faculty of Dentistry at Sana'a University. Digital periapical radiographs of 352 posts restoring endodontically treated teeth (ETT) were collected from public and private universities, dental X-ray centers, and clinics. Radiographs with inadequate diagnostic quality were excluded.
Using ImageJ software (1.53e), the radiographs were resized and measured according to predefined criteria. Pixel measurements were converted to millimeters using a calibration based on the known dimensions of the radiographic film. Data for each sample were recorded in a standardized form.
The data were collected and recorded in an Excel spreadsheet. The term "ideal" was assigned to data that adhered to the guidelines outlined in Table 1. The following parameters were evaluated:
• Involved jaw
• Tooth type
• Post type
• Post shape
• Post diameter
• Post length
• Residual GP length
• Space between GP and post
| Post diameter | Equal to 1/3 of the root width |
| Post length related to the root length | Equal to 2/3 of root length |
| Post length related to the crown height | Equal to or more than crown height |
| Length of the remaining gutta-percha | Range 3–5 mm in length |
| The space between the post end and root canal filling | No space present |
Table 1: Principal Guidelines for Post-Space Preparation
Statistical analysis was performed using SPSS software (version 21). Descriptive statistics were generated, and the association between different variables was determined using the chi-square test at a significance level of 0.05.
A retrospective study analyzed 352 postoperative periapical radiographs of endodontically treated teeth in Sana'a, Yemen. The sample was evenly distributed between the maxillary and mandibular arches. Prefabricated metal posts were the most common (58%), followed by prefabricated fiber posts (38%). Only 4% were custom-made. Most posts (58.2%) were parallel-sided, while the remaining were tapered (41.8%). Premolars were most frequently restored with posts (41.2%), followed by molars and anterior teeth (36.6% and 22.2%, respectively).
Posts were evaluated based on ideal prosthetic criteria. Results showed that:
The analysis revealed that many restored ETT in Sana'a had short posts less than two thirds of the root lengths, some of them with gaps between the post and the crown. Most post widths were less than one-third of the root. Post-crown lengths frequently equal or more than crown height. A significant number of cases had a GP length more than 5 mm. These findings highlight common prosthetic design shortcomings in the region and suggest areas for improvement.
Table 2: Post Frequency and Percentage of Arch, Type of Tooth, Type of Post, Shape of Post.
Figure 1: Percentage of prosthetic criteria analyzed (n=352).
The evaluation of endodontically treated teeth (ETT) restored with post and core restorations is contingent upon specific criteria assessed both clinically and radiographically. This study focused solely on radiographic assessment using digital periapical images. Maxillary and mandibular teeth were restored with posts in a nearly balanced distribution, contradicting previous findings that favored maxillary teeth. Premolars were the most frequently restored teeth, aligning with many studies. Prefabricated metal posts were the most common, followed by prefabricated fiber posts. This differs from studies reporting a predominance of prefabricated fiber posts. Custom-made posts were rarely used, suggesting their obsolescence. Parallel posts were more prevalent than tapered posts, contrary to some studies. The majority of post widths were less than one-third of the root diameter, aligning with some studies but diverging from others. Post length was often less than the recommended 2:3 ratio to root length, potentially due to post type. A significant proportion of posts were at least as long as the crown height. Most cases had adequate GP retention, with less than 3 mm remaining in only a few. Most cases exhibited no gap between the post and the remaining GP, although some had gaps ranging from 0.2 mm to 5.1 mm. The discrepancies observed in this study compared to previous research may be attributed to factors such as sample size, operator expertise, post type, and the specific criteria used for evaluation. The balance between maxillary and mandibular teeth might reflect a shift in treatment preferences or regional variations. The prevalence of metal posts could be due to cost, availability, or perceived strength. The preference for parallel posts might be related to perceived retention or ease of fabrication. Inadequate post preparation or a focus on preserving remaining dentin could contribute to smaller post diameters. The shorter post lengths might be influenced by concerns about apical seal or root strength. The high percentage of adequate GP retention suggests a cautious approach to endodontic treatment.
The findings of this study highlight the variability in post and core restoration practices. A standardized approach, emphasizing proper post preparation, selection, and placement, is essential to ensure the long-term success of these restorations. Further research is needed to establish evidence-based guidelines for post and core treatment
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