Keywords

Cast Post; Dead Space; Endodontic Therapy.

Introduction

The success of an endodontic treatment is 53%-96% [33, 7]. It depends on many factors like tooth type, preoperative operator skills and quality of coronal seal. The longevity of endodontically treated teeth has been greatly enhanced by continuing advancements made in endodontic therapy and restorative procedures [5, 16, 21, 28].

Endodontically treated teeth are often broken teeth which requires restoration with endodontic post. The main purpose of post is to retain the permanent restoration and disperse the factors along the long axis of the tooth to the periodontium [29, 8].

However the seal provided by a complete full length of obturation gets compromised after post space preparation. Coronal microleakage into the root canal by bacteria can lead to failure of endodontic therapy [5, 16, 20, 28]. So, immediate and proper coronal restoration is very important [6, 12].

Apical leakage is one of the most important factors in the outcome of endodontic traenmentr and is positively correlated with technical quality of the root canal filling [10, 26].

Recent epidemiologic studies that evaluated the success rate of root filled teeth have stated that the leakage from the oral environment along the root canal filling to the periapical region was also a contributing factor [32, 27]. The significance of coronal restoration on periradicular heath was also supported by ex vivo study [35, 38].

A custom made cast post can either be cast from a direct pattern or an indirect pattern. In case of the direct technique, the pattern can either be made using inlay wax or it can be made using pattern resin. In case of conventional indirect technique, an elastomeric impression material along with some kind of reinforcement is used [3]. So the aim of the study was to evaluate the dead space in postendodotically treated cast post cases.

Materials And Methods

This retrospective study was carried out at Department Of Conservative Dentistry And Endodontic, Saveetha dental college and hospitals, Chennai.

As this study was entirely based on data collection from existing dental records available in DIAS (Dental Information Archiving Software) Saveetha Dental College, ethical clearance was not obtained. Dental record of the patients who had undergone treatment for the management of badly broken down teeth with cast post from June 2019 to March 2020 were retrospectively examined by single examiner.

Only the patient who had got their treatment done by the same clinician and full dental records were included for the study. Data were collected from 70 patient records. Following data were collected from each patient - Age, Gender, Type of teeth and the radiographs of each were evaluated for the dead space (Distance between obturating material and the post), and were broadly divided into three categories based on this into Group I,II and III.

I-No gap- 0mm
II-less than 2mm
III-more than 2mm [Table 1]
Data were tabulated in excel sheets and statistical analysis was done using SPSS 21.0 version.

Descriptive analysis of the data obtained was done and Chi square test was done to check the association between Age, Gender and Number of cases.

Results And Discussion

A total of 70 cases were examined. 21% of cases were grouped into group I, 68% were categorised under group II and 1% of cases were grouped under Group III.

On the whole, most of the cases belonged to the 21-30 age group-57%. Minimum number of cases were reported in 61-70 age group-13%.

Maximum number of cases were reported in Male-62%, Minimum number of cases were reported in Female-37%. When the association between the age groups and the teeth was checked, it was found to be not significant with P value more than 0.05.

This is a retrospective study based on the evaluation of radiographs. A major drawback of this type of analysis is the impossibility of deciding whether aperiapicalpathosis is healing or not because of its gives only static description of the dynamic inflammatory process [13, 17, 36, 31, 14].

This study is based on evaluation of periapical radiographs. There have been doubts about the sensitivity of the periapical radiographs in terms of detection of periapical status evaluation. However, Mohammed et al showed no significant difference between panoramic and periapical radiographs. This finding was also supported by Ahlquest et al [2, 24].

Endodontically treated teeth most commonly receive post retained restoration [34, 19, 30]. Recently, more studies have been focussed on the coronal leakage of the post restoration. Results showed that not only the length of remaining root canal filling but also the adhesion between the post and root canal dentin played a key role in coronal microleakage.

It has been mentioned that the seal of the post and core had to be improved for the prevention of recontamination [1, 22, 25]. Fogel et al showed that none of the stainless steel based post systems were capable of achieving a fluid tight seal regardless of the luting material [9]. Moreover, poor cementation of temporary crown or temporary post is also an important factor in coronal leakage.

The gap between the post and the remaining root canal filling is another decisive factor in the invasion of microorganisms after post restoration. Nevertheless, there are few studies about the effect of this gap in the success of the endodontically treated teeth. It is obvious that the root canals should be hermetically obturated for the topmost outcomes [18, 20, 36].

McAndrew et al, mentioned in his study that the gap between the post and the obturating material could be a contributing factor in the prognosis of endodontically treated teeth [11, 15].

Because one of the primary functions of the root canal filling is entombing the bacteria in the dentinal tubules. However the space between the post and the obturating material (Dead space) can be a good shelter for the microorganisms that negatively affect the outcome of the endodontic therapy.

A custom made cast post can be fabricated by direct or indirect technique. The main disadvantage of this technique is that if the selected reinforcement, i.e., the wire or plastic post is too tight, then the impression material strips away from it when the impression is removed. Furthermore, placing the reinforcement into the canal is an additional time‑consuming procedure. In addition, seating the reinforcement onto the orifices of the root canals may be difficult or impractical in cases with difficult clinical access or in cases where multiple teeth are involved [3, 4].

In teeth with cast post, the explanation of this gap may be inaccurate impression of post space or thermal contraction of metal alloys during casting procedure. Therefore radiographic confirmation of post adaptation should be performed before cementation of all kinds of posts [23, 39].

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Table 1:

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Table 1. Criteria for the dead space evaluation.

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Table 2:

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Table 2. Number of Cases in each Group.

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Figure 1:

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Figure 1. This bar chart represents the dead space in cast post cases. x-axis represents the group and y-axis represents the total number of teeth. Most of the teeth had group 2 which is dead space of less than 2mm.

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Figure 2:

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Figure 2. Bar graph represents the distribution of cast post cases with relation to tooth number. X-axis represents the groups and the y-axis gives the total number of teeth. The most common teeth seen in all the three groups was 11 (maxillary central incisors).

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Figure 3:

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Figure 3. This bar graph represents the distribution of cast post cases in all three groups . X-axis gives the teeth number and y-axis gives the count of teeth, The most common teeth seen is 11 among all three groups.

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Figure 4:

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Figure 4. Bar graph represents the association between groups and count of teeth. X Axis represents the groups and Y axis represents the count of teeth in each group. Chi square test was done and association was found to be statistically not significant. Pearson’s Chi square value:8.598, Df:10, p value:0.571 (>0.05).

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Conclusion

Within the limitation of the study, most of the cases had an average dead space of 0.1-2 mm (68%). The dead space can be a good shelter for the microorganisms. So, radiographic confirmation of the post adaptation should be performed before cementation of all kinds of posts.

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