Clinical evaluation of root filled teeth restored with or without post-and-core systems in a specialist practice setting. Composite resin core-crown reconstructions: an up to 17-year follow-up of a controlled clinical trial.
AIM To assess survival rates and complications of  root-filled teeth restored with or without post- and -core systems  over a mean observation period of > or=4 years . METHODOLOGY A total of 325 single- and multirooted teeth in 183 subjects treated in a private practice were root filled and restored with either a cast post- and -core or with a prefabricated titanium post and composite core . Root-filled teeth without post-retained restorations served as controls . The restored teeth served as abutments for single unit metal-ceramic or composite crowns or fixed bridges . Teeth supporting cantilever bridges , overdentures or telescopic crowns were excluded . RESULTS Seventeen teeth in 17 subjects were lost to follow-up ( 17/325 : 5.2 % ) . The mean observation period was 5.2 + /- 1.8 ( SD ) years for restorations with titanium posts , 6.2 + /- 2.0 ( SD ) years for cast post- and -cores and 4.4 + /- 1.7 ( SD ) years for teeth without posts . Overall , 54 % of build-ups included the incorporation of a titanium post and 26.5 % the cementation of a cast post- and -core . The remaining 19.5 % of the teeth were restored without intraradicular retention . The adjusted 5-year tooth survival rate amounted to 92.5 % for teeth restored with titanium posts , to 97.1 % for teeth restored with cast post- and -cores and to 94.3 % for teeth without post restorations , respectively . The most frequent complications included root fracture ( 6.2 % ) , recurrent caries ( 1.9 % ) , post-treatment periradicular disease ( 1.6 % ) and loss of retention ( 1.3 % ) . CONCLUSION Provided that high- quality root canal treatment and restorative protocol s are implemented , high survival and low complication rates of single- and multirooted root-filled teeth used as abutments for fixed restorations can be expected after a mean observation period of > or=4 years PURPOSE The aim of this long-term follow-up study was to collect up to 17 years of survival data of endodontically treated single teeth with or without a prefabricated metal post .  MATERIAL S AND METHODS Single teeth were provided with direct composite resin core-crown reconstructions with or without posts by 15 operators . Restorations consisted of either a prefabricated metal post and a composite core-crown reconstruction or a post-free direct composite reconstruction . Allocation of either restoration was performed by balanced drawing . These restorations were not covered by an artificial crown . The study sample consisted of 87 patients who received 98 core-crown reconstructions .  The performance of the restorations was evaluated based on data collected from the files of the clinicians currently monitoring the oral health of the patients . The survival probability was analyzed at different levels : on the restoration level and on the level of the tooth carrying the restoration . Kaplan-Meier analysis was used to compare survival probabilities . RESULTS Post placement showed no influence on the survival probability at either level ( P > .05 ) . The estimated overall survival rate at 17 years was 53 % + /- 14 % at the restoration level and 79 % + /- 11 % at the tooth level . CONCLUSION The results of this long-term follow-up study showed no difference in survival probabilities between different direct composite resin core-crown reconstructions of endodontically treated single teeth ( with or without a post )
A comparison of fracture loads in the in vitro studies revealed no significant difference between cast and direct posts and cores .
Meta- analysis of the data suggested that there is no difference in fracture behavior associated with the 2 treatment modalities .
Direct  post- and -core restorations with prefabricated posts are becoming increasingly popular .
A literature review was conducted to compare the clinical and in vitro performance of cast posts and cores to that of direct cores with prefabricated posts in single-rooted teeth .