Objectives: Glass-fiber posts are claimed to have more favorable mechanical properties than cast gold post-and-cores when restoring endodontically treated teeth. Aim of this RCT is to investigate whether cast post-and-cores can still be considered the ‘gold-standard' to restore endodontically treated teeth or if adhesive post-and-core techniques do perform clinically better.
Methods: 144 patients in need for a restoration on an endodontically treated tooth were followed-up for 7-37 months (mean: 21±9 months). 205 restorations were placed and allocated to one of the following treatment groups: A) cast gold post-and-core (control, Medior 3, Cendres+Métaux); B) prefabricated glass-fiber post (Parapost-FiberLux, Coltène-Whaledent); C) custom-made glass-fiber posts (EverStick, StickTech); and D) composite core without post (Clearfil AP-X, Kuraray). All post-and-cores were covered by an all-ceramic crown (Procera, Nobel-Biocare). Allocation was randomized and based on the remaining tissue available for bonding as follow:
Dental tissue left | Randomization |
a. Sufficient (≥2 walls with 2mm thickness) | Group A/D |
b. Insufficient (<2 walls with 2mm thickness) | Group A/B (small root canal) |
C (wide root canal) |
Failures were distinguished as ‘absolute' in case of fractures of the root or irreparable fractures of the core build-up, as ‘relative' in case of loss of post retention or reparable fractures of the core build-up. ‘Other' failures included endodontic or periodontal complications. Kaplan-Meier survival curves were drawn.
Results: The recall rate at 3 years was 97.1%. No significant differences could be observed among the 4 groups evaluated, because of few failures. The survival probability was 97.3% for ‘absolute' failures due to 2 root fractures, and 94.1% for ‘relative' failures due to 3 retention losses of post-and-core and 1 post fracture. One tooth failed because of endodontic complications.
Conclusion: Up to 3-years, both cast gold and adhesive post-and-core techniques performed clinically equally successfully, although longer follow-up times may be needed to determine significant differences.