Douglas A. Terry - Restoring the Intraradicular Space

• Liquid phosphoric acid applied with an endodontic needle removed the smear layer better than gel etchants, and higher bond strengths to the dentin were achieved when an etch-and-rinse adhesive system was utilized.212 ,226 ,227

• An application of CHX after etching and rinsing as a protease inhibitor for MMPs261 and cysteine cathepsins270 can preserve the hybrid layer from degradation.

• The selection of lower-viscosity resin cements improves wetting of the etched dentin, producing improved interfacial internal adaptation and reducing void formations.344

• An adhesively placed fiber-reinforced composite post system provides an uninterrupted bonding at all interfaces, resulting in increased resistance to fatigue and fracture, enhanced retention, and a reduction in microleakage and bacterial infiltration.

• The anatomical formed post system decreases the volume of adhesive material in the post space, reduces gap formation at the dentin-cement interface,440 ,453 reduces the undesirable effects of polymerization shrinkage, and increases bond strengths.388 ,454

• Effective bonding to radicular dentin requires a strict protocol with accuracy and attention to detail.

• Generally, dual-cured and self-cured resin cements are recommended when fiber posts are used because of the attenuation at the increased depths of the post channel.200 ,508 One post system, the iLumi post, transmits light to the apex and increases post retention at the apical, middle, and coronal sections of the tooth even when a light-cured cement was used.200

• Composites are considered to be unequaled for use as a core buildup in comparison to the glass ionomers. Composites enhance the retention and fracture resistance of the fiber post.166 ,353 ,411 ,433 ,517 –519

• Various composite materials have been investigated for their use as a core material, which include conventional hybrid composites, flowable composites, and bulk-filled composites.411 ,479 ,518 ,521 –524

• Adhesively cemented fiber posts exhibit less microleakage than when fiber posts are cemented with glass-ionomer or zinc phosphate.672

• By developing a monoblock system with components of the post assembly, the force distribution in the root is improved. 36

Restoration

• Anterior teeth with minimal loss of tooth structure can be restored without post systems and with conservative composite restorations. 51

• Endodontically treated molars have significantly more cuspal deflection than intact molars,315 making the endodontically treated tooth more susceptible to coronal fractures531 ,532; therefore, cuspal coverage is required.

• A full-coverage crown is required for endodontically treated anterior teeth with significant loss of tooth structure. A fiber-reinforced post and composite core improves esthetics of the final ceramic restoration.

• The presence of two proximal contacts improves the survival rate of ETT.213 ,534

Occlusal forces

• The objective of a post and core assembly is to transfer occlusal loads into the root and to reinforce the buildup.346

• Posterior teeth receive compressive loads in an occlusogingival or vertical direction, whereas anterior teeth receive flexural stresses in a horizontal or lateral direction. 69 ,389

• Horizontal forces generated by parafunction may increase the risk of failure for ETT.388 ,389

• To minimize the magnitude of stresses on ETT, the occlusal design should be created to allow for occlusal points of contact while minimizing broad contact areas.388 ,390 ,391 Furthermore, occlusal interferences should be periodically evaluated and equilibrated as needed.388 ,392

• The occlusal forces on ETT should be reduced in the presence of compromised periodontium.159

“It is not which materials we use but how we use them with the proper techniques and concepts to create esthetic and restorative excellence.”

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