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ePaper created 2016-01-20, 13:53:08 | version 1.38.0
22 I I case report _ composite restoration _Therestorationofteethutilisingcompositesstill presents a myriad of clinical challenges for the dental clinician. This is especially true for extensively broken down teeth and as well, those teeth which have been accessed endodontically. Fibre posts such as the quartz Macro-Lock Illusion X-RO post (Recherches TechniquesDentaires—RTD)UniCoreFiberpost(Ultra- dent), and DT Light-Post (RTD) are now the posts of choiceforadirectoneappointmentrestorationofthe severely compromised endodontically treated tooth. Currentresearchsupportstheuseofanetchandrinse bonding protocol, with a compatible bonding agent, utilising a dual-cured composite cement that can be utilised for the core as well (Cosmecore—Cosmedent; CoreCem—RTD; Zircules—Clinician’s Choice) for best results.1, 2 Traditionally, minimally accessed endodon- tically treated teeth that are not extensively compro- mised by caries or fracture, have been restored solely with a composite core, without the placement of a post. This decision must be based on the amount of tooth structure left, and if a full coverage restoration is to be placed now or in the future. The width and heightoftheferruleremainingiscriticaltorestorative success(Figs.1a&b),3-6 aswellasthenumberoftooth wallsleft,postpreparation,whichsignificantlyaffects the long-term restorative outcome (Fig. 2).6-8 In a review of 41 articles published between 1969 and 1999 (the majority from the 90s), Heling states that‘theliteraturesuggeststhattheprognosisofroot canal-treated teeth can be improved by sealing the canal and minimising the leakage of oral fluids and bacteria into the peri-radicular areas as soon as pos- sible after completion of root canal therapy.’9 A simi- larreviewbySaundersetalalsoconcludedthatcoro- nal leakage of root canals is a major cause of root canal failure.10 Sritharan states that ‘it has been sug- gested that apical leakage may not be the most im- portant factor leading to the failure of endodontic treatment—butthatcoronalleakageisfarmorelikely tobethemajordeterminantofclinicalsuccessorfail- ure.’11 Coronal microleakage can occur due to a defi- cient final restoration (due to resultant microleakage from polymerisation contraction, cement wash out, poor full coverage, flex etc) and resultant secondary caries.12 Fig. 1a_Schematic diagram of a molar with conservative access opening, which when restored with a core only, will leave sufficient width and height of dentin to act as a ferrule resisting failure. Fig. 1b_The same tooth with a widely divergent access opening, restored with Macrolock posts and composite core, when prepared for a full coverage restoration will not leave sufficient dentine (no ferrule), resulting in a stand-alone core which will drastically influence failure rate. Fig. 2_Schematic diagram of the molar in Figure 1a, but with Macrolock Fiber Post segments as inserts to decrease composite volume and increase polymerisation factors. roots1_2015 Rationale for the suggested use of fibre post segments in composite core build-ups for endodontically treated teeth Authors_ Drs Leendert Boksman & Gary Glassman, Canada Fig. 1a Fig. 1b Fig. 2