Skip to main content

Advertisement

SpringerLink
Log in

Do We Still Need Intraradicular Retainers? Current Perspectives on the Treatment of Endodontically Treated Teeth

  • Published:
Current Oral Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Finding a balance between mechanical function of endodontically treated teeth and minimal remnant preparation is challenging. Minimally adhesive concepts are being explored as an alternative to the use of posts, cores, and classical fixed prostheses. Thereby, this review seeks to highlight and discuss the current knowledge on this issue.

Recent Findings

Considering the mechanical characteristics encountered in the different regions of the dental arch, recent evidence points to the benefits of endocrown restorations for the posterior region, being a promising option for molars and premolars (predominant axial load); however, intraradicular retainers are still suggested for the anterior region due to the incidence of lateral loads triggered by the oblique positioning and the main occurrence of flexural loads.

Summary

The quality of the remaining tooth, the possibility of maintaining the ferrule effect, and the region of the element to be treated are key factors that must be considered in the rehabilitation of pulpless teeth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Morgano SM. Restoration of pulpless teeth: application of traditional principles in present and future contexts. J Prosthet Dent. 1996;75:375–80. https://doi.org/10.1016/S0022-3913(96)90028-1.

    Article  CAS  PubMed  Google Scholar 

  2. Marchionatti AME, Wandscher VF, Rippe MP, Kaizer OB, Valandro LF. Clinical performance and failure modes of pulpless teeth restored with posts: a systematic review. Braz Oral Res. 2017;31:e64. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0064.

    Article  PubMed  Google Scholar 

  3. Bolla M, Muller-Bolla M, Borg C, Lupi-Pegurier L, Laplanche O, Leforestier E. Root canal posts for the restoration of root filled teeth. Cochrane Database Syst Rev. 2016;2016:3–6. https://doi.org/10.1002/14651858.CD004623.pub3.

    Article  Google Scholar 

  4. de Kuijper MCFM, Cune MS, Özcan M, Gresnigt MMM. Clinical performance of direct composite resin versus indirect restorations on endodontically treated posterior teeth: a systematic review and meta-analysis. J Prosthet Dent 2022:1–12. https://doi.org/10.1016/j.prosdent.2021.11.009.

  5. Rocca GT, Daher R, Saratti CM, Sedlacek R, Suchy T, Feilzer AJ, et al. Restoration of severely damaged endodontically treated premolars: the influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. J Dent. 2018;68:41–50. https://doi.org/10.1016/j.jdent.2017.10.011.

    Article  CAS  PubMed  Google Scholar 

  6. Sarkis-Onofre R, Jacinto RDC, Boscato N, Cenci MS, Pereira-Cenci T. Cast metal vs. glass fibre posts: a randomized controlled trial with up to 3 years of follow up. J Dent. 2014;42:582–7. https://doi.org/10.1016/j.jdent.2014.02.003.

    Article  CAS  PubMed  Google Scholar 

  7. Comba A, Baldi A, Saratti CM, Rocca GT, Torres CRG, Pereira GKR, et al. Could different direct restoration techniques affect interfacial gap and fracture resistance of endodontically treated anterior teeth? Clin Oral Investig. 2021;25:5967–75. https://doi.org/10.1007/s00784-021-03902-y.

    Article  PubMed  PubMed Central  Google Scholar 

  8. • Iaculli F, Rengo C, Lodato V, Patini R, Spagnuolo G, Rengo S. Fracture resistance of endodontically-treated maxillary premolars restored with different type of posts and direct composite reconstructions: a systematic review and meta-analysis of in vitro studies. Dent Mater. 2021;37:e455-84. https://doi.org/10.1016/j.dental.2021.06.007. A current systematic review evaluating the use of fiber posts suggests that endodontically treated maxillary premolars restored with fiber post and direct composite resin restoration demonstrated greater fracture resistance when compared to equivalent teeth without a retainer.

    Article  CAS  PubMed  Google Scholar 

  9. Girotto LPS, Dotto L, Pereira GKR, Bacchi A, Sarkis-Onofre R. Restorative preferences and choices of dentists and students for restoring endodontically treated teeth: a systematic review of survey studies. J Prosthet Dent. 2021;126:489-489.e5. https://doi.org/10.1016/j.prosdent.2020.07.005.

    Article  PubMed  Google Scholar 

  10. Santos AFV, Meira JBC, Tanaka CB, Xavier TA, Ballester RY, Lima RG, et al. Can fiber posts increase root stresses and reduce fracture? J Dent Res. 2010;89:587–91. https://doi.org/10.1177/0022034510363382.

    Article  CAS  PubMed  Google Scholar 

  11. Zhou L, Wang Q. Comparison of fracture resistance between cast posts and fiber posts: a meta-analysis of literature. J Endod. 2013;39:11–5. https://doi.org/10.1016/j.joen.2012.09.026.

    Article  PubMed  Google Scholar 

  12. Wandscher VF, Bergoli CD, Limberger IF, Ardenghi TM, Valandro LF. Preliminary results of the survival and fracture load of roots restored with intracanal posts: weakened vs nonweakened roots. Oper Dent. 2014;39:541–55. https://doi.org/10.2341/12-465.

    Article  CAS  PubMed  Google Scholar 

  13. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, et al. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res. 2012;91:S72–8. https://doi.org/10.1177/0022034512447949.

    Article  Google Scholar 

  14. Figueiredo FED, Martins-Filho PRS, Faria-E-Silva AL. Do metal post-retained restorations result in more root fractures than fiber post-retained restorations? A systematic review and meta-analysis. J Endod. 2015;41:309–16. https://doi.org/10.1016/j.joen.2014.10.006.

    Article  PubMed  Google Scholar 

  15. Scotti N, Rota R, Scansetti M, Paolino DS, Chiandussi G, Pasqualini D, et al. Influence of adhesive techniques on fracture resistance of endodontically treated premolars with various residual wall thicknesses. J Prosthet Dent. 2013;110:376–82. https://doi.org/10.1016/j.prosdent.2013.08.001.

    Article  PubMed  Google Scholar 

  16. de Coelho CSM, Biffi JCG, da Silva GR, Abrahão A, Campos RE, Soares CJ. Finite element analysis of weakened roots restored with composite resin and posts. Dent Mater J. 2009;28:671–8. https://doi.org/10.4012/dmj.28.671.

    Article  PubMed  Google Scholar 

  17. Parisi C, Valandro LF, Ciocca L, Gatto MRA, Baldissara P. Clinical outcomes and success rates of quartz fiber post restorations: a retrospective study. J Prosthet Dent. 2015;114(3):367–72.

    Article  PubMed  Google Scholar 

  18. Martins MD, Junqueira RB, de Carvalho RF, Lacerda MFLS, Faé DS, Lemos CAA. Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis. J Dent 2021;112. https://doi.org/10.1016/j.jdent.2021.103750.

  19. Sarkis-Onofre R, AmaralPinheiro H, Poletto-Neto V, Bergoli CD, Cenci MS, Pereira-Cenci T. Randomized controlled trial comparing glass fiber posts and cast metal posts. J Dent. 2020;96:103334. https://doi.org/10.1016/j.jdent.2020.103334.

    Article  CAS  PubMed  Google Scholar 

  20. • Sarkis-Onofre R, Fergusson D, Cenci MS, Moher D, Pereira-Cenci T. Performance of post-retained single crowns: a systematic review of related risk factors. J Endod. 2017;43:175–83. https://doi.org/10.1016/j.joen.2016.10.025. Review article that emphasizes the importance of remaining coronary walls in the choice of root retainers.

    Article  PubMed  Google Scholar 

  21. Machry RV, Fontana PE, Bohrer TC, Valandro LF, Kaizer OB. Effect of different surface treatments of resin relined fiber posts cemented with self-adhesive resin cement on push-out and microtensile bond strength tests. Oper Dent. 2020;45:E185–95. https://doi.org/10.2341/19-108-L.

    Article  CAS  PubMed  Google Scholar 

  22. Ruschel GH, Gomes ÉA, Silva-Sousa YT, Pinelli RGP, Sousa-Neto MD, Pereira GKR, et al. Mechanical properties and superficial characterization of a milled CAD-CAM glass fiber post. J Mech Behav Biomed Mater. 2018;82:187–92. https://doi.org/10.1016/j.jmbbm.2018.03.035.

    Article  CAS  PubMed  Google Scholar 

  23. Oliveira GR, Machry RV, Cadore-Rodrigues AC, Sarkis-Onofre R, Valandro LF, Bacchi A, Pereira G, Spazzin AO. Fatigue properties of weakened and non-weakened roots restored with CAD-CAM milled fiber post, prefabricated fiber post, or cast metal post. Oper Dent. 2022;47(6):658–69. https://doi.org/10.2341/21-032-L.

    Article  CAS  PubMed  Google Scholar 

  24. Hill EE. Dental cements for definitive luting: a review and practical clinical considerations. Dent Clin North Am. 2007;51:643–58. https://doi.org/10.1016/j.cden.2007.04.002.

    Article  PubMed  Google Scholar 

  25. Valandro LF, Andreatta Filho OD, Valera MC, Maximo De Araujo MA. The effect of adhesive systems on the pullout strength of a fiberglass-reinforced composite post system in bovine teeth. J Adhes Dent. 2005;7(4):331–6.

  26. Amaral M, Santini MF, Wandscher V, Amaral R, Valandro LF. An in vitro comparison of different cementation strategies on the pull-out strength of a glass fiber post. Oper Dent. 2009;34(4):443–51.

    Article  CAS  PubMed  Google Scholar 

  27. Bottino MA, Baldissara P, Valandro LF, Galhano GA, Scotti R. Effects of mechanical cycling on the bonding of zirconia and fiber posts to human root dentin. J Adhes Dent. 2007;9(3):327–31.

  28. Baldissara P, Zicari F, Valandro LF, Scotti R. Effect of root canal treatments on quartz fiber posts bonding to root dentin. J Endod. 2006;32(10):985–8.

  29. Tay FR, Pashley DH. Monoblocks in root canals: a hypothetical or a tangible goal. J Endod. 2007;33:391–8. https://doi.org/10.1016/j.joen.2006.10.009.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bergoli CD, Amaral M, Boaro LCC, Braga RR, Valandro LF. Fiber post cementation strategies: effect of mechanical cycling on push-out bond strength and cement polymerization stress. Fiber Post Cem Strateg Eff Mech Cycl Push-out Bond Strength Cem Polym Stress. 2012;14:471–8. https://doi.org/10.3290/j.jad.a28389.

    Article  Google Scholar 

  31. Biacchi GR, Mello B, Basting RT. The endocrown: an alternative approach for restoring extensively damaged molars. J Esthet Restor Dent. 2013;25:383–90. https://doi.org/10.1111/jerd.12065.

    Article  PubMed  Google Scholar 

  32. Dartora NR, Maurício Moris IC, Poole SF, Bacchi A, Sousa-Neto MD, Silva-Sousa YT, et al. Mechanical behavior of endocrowns fabricated with different CAD-CAM ceramic systems. J Prosthet Dent. 2021;125:117–25. https://doi.org/10.1016/j.prosdent.2019.11.008.

    Article  CAS  PubMed  Google Scholar 

  33. Blatz MB, Conejo J. The current state of chairside digital dentistry and materials. Dent Clin North Am. 2019;63:175–97. https://doi.org/10.1016/j.cden.2018.11.002.

    Article  PubMed  Google Scholar 

  34. da Cunha LF, Gonzaga CC, Pissaia JF, Correr GM. Lithium silicate endocrown fabricated with a CAD-CAM system: a functional and esthetic protocol. J Prosthet Dent. 2017;118:131–4. https://doi.org/10.1016/j.prosdent.2016.10.006.

    Article  CAS  PubMed  Google Scholar 

  35. Tribst JPM, de Dal Piva AMO, Madruga CFL, Valera MC, Borges ALS, Bresciani E, et al. Endocrown restorations: influence of dental remnant and restorative material on stress distribution. Dent Mater. 2018;34:1466–73. https://doi.org/10.1016/j.dental.2018.06.012.

    Article  CAS  PubMed  Google Scholar 

  36. Zicari F, Van Meerbeek B, Scotti R, Naert I. Effect of fibre post length and adhesive strategy on fracture resistance of endodontically treated teeth after fatigue loading. J Dent. 2012;40:312–21. https://doi.org/10.1016/j.jdent.2012.01.006.

    Article  CAS  PubMed  Google Scholar 

  37. Lazari PC, de Oliveira RCN, Anchieta RB, de Almeida EO, Freitas Junior AC, Kina S, et al. Stress distribution on dentin-cement-post interface varying root canal and glass fiber post diameters. A three-dimensional finite element analysis based on micro-CT data. J Appl Oral Sci. 2013;21:511–7. https://doi.org/10.1590/1679-775720130203.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Altier M, Erol F, Yildirim G, Dalkilic EE. Fracture resistance and failure modes of lithium disilicate or composite endocrowns. Niger J Clin Pract. 2018;21:821–6. https://doi.org/10.4103/njcp.njcp_175_17.

    Article  CAS  PubMed  Google Scholar 

  39. Hayes A, Duvall N, Wajdowicz M, Roberts H. Effect of endocrown pulp chamber extension depth on molar fracture resistance. Oper Dent. 2017;42:327–34. https://doi.org/10.2341/16-097-L.

    Article  CAS  PubMed  Google Scholar 

  40. Sedrez-Porto JA, da Rosa de WLO, da Silva AF, Münchow EA, Pereira-Cenci T. Endocrown restorations: a systematic review and meta-analysis. J Dent. 2016;52:8–14. https://doi.org/10.1016/j.jdent.2016.07.005.

    Article  PubMed  Google Scholar 

  41. Dartora G, Rocha Pereira GK, Varella de Carvalho R, Zucuni CP, Valandro LF, Cesar PF, et al. Comparison of endocrowns made of lithium disilicate glass-ceramic or polymer-infiltrated ceramic networks and direct composite resin restorations: fatigue performance and stress distribution. J Mech Behav Biomed Mater. 2019;100:103401. https://doi.org/10.1016/j.jmbbm.2019.103401.

    Article  CAS  PubMed  Google Scholar 

  42. Motta AB, Pereira LC, Duda FP, Anusavice KJ. Influence of substructure design and occlusal reduction on the stress distribution in metal ceramic complete crowns: 3D finite element analysis. J Prosthodont. 2014;23:381–9. https://doi.org/10.1111/jopr.12119.

    Article  PubMed  Google Scholar 

  43. Tribst JPM, de Dal Piva AMO, de Jager N, Bottino MA, de Kok P, Kleverlaan CJ. Full-crown versus endocrown approach: a 3D-analysis of both restorations and the effect of ferrule and restoration material. J Prosthodont. 2021;30:335–44. https://doi.org/10.1111/jopr.13244.

    Article  PubMed  Google Scholar 

  44. Zheng Z, Sun J, Jiang L, Wu Y, He J, Ruan W, et al. Influence of margin design and restorative material on the stress distribution of endocrowns: a 3D finite element analysis. BMC Oral Health. 2022;22:1–12. https://doi.org/10.1186/s12903-022-02063-y.

    Article  CAS  Google Scholar 

  45. • Govare N, Contrepois M. Endocrowns: a systematic review. J Prosthet Dent. 2020;123:411-418.e9. https://doi.org/10.1016/j.prosdent.2019.04.009. This literature review critically analyzes the current perspectives about endocrowns. The authors concluded that endocrown is a suitable restoration to molars.

    Article  CAS  PubMed  Google Scholar 

  46. Silva-Sousa AC, Moris ICM, Barbosa AFS, Silva-Sousa YTC, Sousa-Neto MD, Pires CRF, et al. Effect of restorative treatment with endocrown and ferrule on the mechanical behavior of anterior endodontically treated teeth: an in vitro analysis. J Mech Behav Biomed Mater. 2020;112:104019. https://doi.org/10.1016/j.jmbbm.2020.104019.

    Article  CAS  PubMed  Google Scholar 

  47. Magne P, Lazari PC, Carvalho MA, Johnson T, Del Bel Cury AA. Ferrule-effect dominates over use of a fiber post when restoring endodontically treated incisors: an in vitro study. Oper Dent. 2017;42:397–406. https://doi.org/10.2341/16-243-L.

    Article  Google Scholar 

  48. de Batista VES, Bitencourt SB, Bastos NA, Pellizzer EP, Goiato MC, dos Santos DM. Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: a systematic review and meta-analysis. J Prosthet Dent. 2020;123:239–45. https://doi.org/10.1016/j.prosdent.2019.01.004.

    Article  PubMed  Google Scholar 

  49. Figueiredo FE, Santos RC, Silva AS, Valdívia AD, Oliveira-Neto LA, Griza S, et al. Ferrule design does not affect the biomechanical behavior of anterior teeth under mechanical fatigue: an in vitro evaluation. Oper Dent. 2019;44:273–80. https://doi.org/10.2341/17-296-L.

    Article  CAS  PubMed  Google Scholar 

  50. Da Silva NR, Raposo LHA, Versluis A, Fernandes-Neto AJ, Soares CJ. The effect of post, core, crown type, and ferrule presence on the biomechanical behavior of endodontically treated bovine anterior teeth. J Prosthet Dent. 2010;104:306–17. https://doi.org/10.1016/S0022-3913(10)60146-1.

    Article  PubMed  Google Scholar 

  51. Juloski J, Radovic I, Goracci C, Vulicevic ZR, Ferrari M. Ferrule effect: a literature review. J Endod. 2012;38:11–9. https://doi.org/10.1016/j.joen.2011.09.024.

    Article  PubMed  Google Scholar 

  52. Skupien JA, Luz MS, Pereira-Cenci T. Ferrule effect: a meta-analysis. JDR Clin Transl Res. 2016;1:31–9. https://doi.org/10.1177/2380084416636606.

    Article  CAS  Google Scholar 

  53. Skupien JA die, Sarkis-Onofre R, Cenci MS érgi, Moraes RR att. de, Pereira-Cenci T. A systematic review of factors associated with the retention of glass fiber posts. Braz Oral Res 2015;29:1–8. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0074.

  54. Naumann M, Schmitter M, Frankenberger R, Krastl G. “Ferrule comes first. post is second!” Fake news and alternative facts? Systematic review. J Endod. 2018;44:212–9. https://doi.org/10.1016/j.joen.2017.09.020.

    Article  PubMed  Google Scholar 

  55. Garcia PP, Wambier LM, de Geus JL, da Cunha LF, Correr GM, Gonzaga CC. Do anterior and posterior teeth treated with post-and-core restorations have similar failure rates? A systematic review and meta-analysis. J Prosthet Dent. 2019;121:887-894.e4. https://doi.org/10.1016/j.prosdent.2018.08.004.

    Article  PubMed  Google Scholar 

  56. Rocca GT, Daher R, Saratti CM, Sedlacek R, Suchy T, Feilzer AJ, et al. Restoration of severely damaged endodontically treated premolars: the influence of the endo-core length on marginal integrity and fatigue resistance of lithium disilicate CAD-CAM ceramic endocrowns. J Dent. 2018;68:41–50. https://doi.org/10.1016/j.jdent.2017.10.011.

    Article  CAS  PubMed  Google Scholar 

  57. Abe Y, Nogami K, Mizumachi W, Tsuka H, Hiasa K. Occlusal-supporting ability of individual maxillary and mandibular teeth. J Oral Rehabil. 2012;39:923–30. https://doi.org/10.1111/joor.12008.

    Article  CAS  PubMed  Google Scholar 

  58. Fráter M, Sáry T, Jókai B, Braunitzer G, Säilynoja E, Vallittu PK, et al. Fatigue behavior of endodontically treated premolars restored with different fiber-reinforced designs. Dent Mater. 2021;37:391–402. https://doi.org/10.1016/j.dental.2020.11.026.

    Article  CAS  PubMed  Google Scholar 

  59. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi L, et al. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res. 2012;91:S72–8. https://doi.org/10.1177/0022034512447949.

    Article  Google Scholar 

  60. Jurema ALB, Filgueiras AT, Santos KA, Bresciani E, Caneppele TMF. Effect of intraradicular fiber post on the fracture resistance of endodontically treated and restored anterior teeth: a systematic review and meta-analysis. J Prosthet Dent. 2022;128:13–24. https://doi.org/10.1016/j.prosdent.2020.12.013.

    Article  PubMed  Google Scholar 

  61. Tsintsadze N, Margvelashvili-Malament M, Natto ZS, Ferrari M. Comparing survival rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts: a systematic review and meta-analyses. J Prosthet Dent 2022:1–12. https://doi.org/10.1016/j.prosdent.2022.01.003.

Download references

Author information

Authors and Affiliations

  1. Post-Graduate Program in Oral Sciences (Prosthodontics Unit), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, Brazil

    Renan Vaz Machry, Kiara Serafini Dapieve, Gabriel Kalil Rocha Pereira & Luiz Felipe Valandro

Authors
  1. Renan Vaz Machry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiara Serafini Dapieve
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel Kalil Rocha Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luiz Felipe Valandro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luiz Felipe Valandro.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

No animal or human subjects by the authors were used in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Machry, R.V., Dapieve, K.S., Pereira, G.K.R. et al. Do We Still Need Intraradicular Retainers? Current Perspectives on the Treatment of Endodontically Treated Teeth. Curr Oral Health Rep 10, 8–13 (2023). https://doi.org/10.1007/s40496-023-00327-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40496-023-00327-2

Keywords

Search

Navigation