Dentists' knowledge, practices, and mishaps in relation to post placement for endodontically treated teeth

Abhinav Kumar Singh

doi:10.4103/ijmo.ijmo_18_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 7 | Issue : 2 | Page : 39-41

Dentists' knowledge, practices, and mishaps in relation to post placement for endodontically treated teeth

Abhinav Kumar Singh
Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, Bihar, India

Date of Submission	07-Dec-2022
Date of Acceptance	11-Dec-2022
Date of Web Publication	30-Dec-2022

Correspondence Address:
Dr. Abhinav Kumar Singh
Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna - 800 020, Bihar
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmo.ijmo_18_22

Abstract

Background: When restoring teeth, the post and core method is often employed. Unfortunately, several reports of endodontically treated teeth failing after placement of this material exist. Objective: The purpose of this research is to determine whether or not dentists have a thorough understanding of the causes of post and core failure. The goal is to evaluate patient outcomes following post coronal restoration procedures, such as post space preparation, post placement, and post final coronal restoration. Methodology: The quantitative methodology has informed a cross-sectional study design. One hundred dentists were chosen at random to fill out the questionnaire, which was then examined statistically. Results: Sodium hypochlorite irrigation, rubber dams, mineral trioxide aggregate management, and follow-up were all mentioned in the findings. Further, it was demonstrated that factors such as tooth size, tooth type, repair time, and repair material all play a role in whether or not a restorative tooth fails. Conclusion: According to the results, the study population had varying degrees of understanding of the post- and core-restorative system. Guidelines should be established to improve restorative practices and expand understanding. Likewise, this aids in avoiding any accidents that could arise as a result of the same causes.

Keywords: Endodontics, failure of post and core system, post and core, post and core system, restorative treatment

How to cite this article:
Singh AK. Dentists' knowledge, practices, and mishaps in relation to post placement for endodontically treated teeth. Int J Med Oral Res 2022;7:39-41

How to cite this URL:
Singh AK. Dentists' knowledge, practices, and mishaps in relation to post placement for endodontically treated teeth. Int J Med Oral Res [serial online] 2022 [cited 2023 May 28];7:39-41. Available from: http://www.ijmorweb.com/text.asp?2022/7/2/39/366311

Introduction

Restoring the tooth's natural function and occlusion and keeping the dental arch stable are the primary objectives of endodontic and restorative treatment. The high clinical success rate of endodontic treatment (95%) means that teeth that were formerly declared nonrestorable and removed may now be saved. Numerous researches^{[1],[2],[3],[4],[5]} have emphasized the significance of parameters such as the kind of final restoration used, the post and core material's design, the quantity of remaining tooth structure, and the existence of a ferrule in influencing the prognosis of endodontically treated teeth. Multiple clinical investigations have demonstrated that the survival percentage of reconstructed maxillary front teeth is greatly increased by the post and core procedure, from 82% to 96% (including a 6–10-year follow-up period).^[6] Despite this, research shows that the post and core system increases tooth restoration complexity.^{[5],[6],[7],[8],[9],[10]} Nevertheless, there is evidence to suggest that the post and core method raises the difficulty bar for tooth restoration.^[10] Dentists have emphasized coronal microleakage as a major cause for concern. The microbe of root canal filing may enter the root canal if a tooth has been insufficiently repaired, thus it is important to have a good seal on the restoration to prevent the bacteria from awakening.^[5] Some researches have shown no difference in apical seal leakage between immediate and delayed post space preparations,^[6],[7] while other researches has found a difference. As a result, the purpose of this research was to determine how often dental professionals' blunders and iatrogenic mistakes are in the context of post space preparation and post installation, with an emphasis on the specifics of these occurrences and their root causes.

Methodology

Information was gathered using a survey with predetermined answers. A web-based questionnaire was made available, and respondents were given 8 weeks to fill it out. The demographic information was gathered in the first section of the questionnaire, and information about the number of posts placed, isolation methods, time spent preparing the post space, and other considerations during canal selection, gutta-percha removal, and post cementation were gathered in the second and third sections, respectively. Data on post space preparation accidents, including patient details, time of occurrence, incident type, tooth details, and treatment options, were gathered in the third section. Three professionals analyzed the questionnaire for face validity before it was distributed and made suggestions for enhancements. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant.

Results

One hundred responses were tallied from the surveys. There were more women than men in the study (57%). Eighty-five percent of respondents said that they have completed <10 fiber posts and cores [Table 1]. Twenty percent of participants were found to favor the usage of rubber dam isolation on a regular basis. When asked what they used for irrigation after the removal of gutta-percha in post space preparation, 89% of participants reported using sodium hypochlorite, whereas 0.5% reported using hydrogen peroxide. Only 26% of respondents indicated that they always or mostly always insert the post at the time of root canal obturation, while 22% said that they never did. Leaving some gutta-percha in the canal during root canal therapy is common practice; in fact, 98% of respondents said that they typically leave between 3 and 5 mm of gutta-percha at the apex. More than 85% of those who had their gutta-percha removed also had post insertion problems. About 30% of these incidents occurred during the removal of gutta-percha, 30% occurred during drilling with various post systems, 30% occurred during post cementation, and 10% occurred during post impression. Seventy-six percent of participants in this research reported experiencing post-related accidents. The majority of broken teeth were located in the upper jaw, or maxilla (72%). Only around one-third of doctors prefer to handle their patients alone, while the rest do post incident follow-ups [Figure 1]. About 44% of the holes were repaired using mineral trioxide aggregate.

Table 1: Number of placed posts within the last year

Click here to view

Figure 1: General dentist referred to a specialist

Click here to view

Discussion

The purpose of this research was to evaluate dentists' level of expertise in various restorative treatments including post and core implantation. Mishap frequency and other factors were also investigated. Twenty percent of individuals were shown to favor rubber dam isolation on a regular basis. A similarly low rate of rubber dam isolation usage after post placement has been observed by Goldfein et al.^[6] NaClO₃ was employed by 89% of the sample as an irrigation solution. This is consistent with the fact that sodium hypochlorite, owing to its potent antibacterial properties and high solubility in tissue, is the solution of choice for root canal irrigation in the vast majority of cases.^[7] Although saline has weak antibacterial activity,^[8] 17% of the sample used it as their primary irrigation fluid anyhow. Ten percent of the people who took part in the current survey said that they preferred to use rotating devices to remove gutta-percha. In reality, experts assured us that mechanical expulsion of gutta-percha utilizing a drill was the most used approach, but this strategy could make some harm tooth structures in the possession of an inexperienced clinician. Seventy-six percent of participants^[9] in the current research reported having had problems with post placement. Seventy-six percent of participants in the current survey reported experiencing problems while placing their posts. Few studies have evaluated the complications of endodontic therapy in general, and none have specifically examined the post placing process.^{[8],[9],[10],[11]} The majority of post space preparation accidents occurred during gutta-percha removal and post space preparation, as would be predicted given the prevalence of rotary devices used for both procedures.^{[10],[11],[12],[13],[14],[15]} The findings of this investigation stress the importance of academic advisors keeping a close eye on their charges during all procedures involving posts and cores but especially during gutta-percha removal and post space preparation.

Conclusion

This study concludes that there is a lack of knowledge among dentists related to post placement for endodontically Treated Teeth. There is a significant prevalence of mishaps during post placement. More preclinical practice should be geared on teaching students how to avoid frequent pitfalls. In addition to its benefits, the research also draws attention to its limitations, such as its localization constraints and the need for restoration. Research in the future may build on this foundation to examine accidents over a broader geographic and demographic range.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Hou QQ, Gao YM, Sun L. Influence of fiber posts on the fracture resistance of endodontically treated premolars with different dental defects. Int J Oral Sci 2013;5:167-71.
2.	Valdivia AD, Raposo LH, Simamoto-Júnior PC, Novais VR, Soares CJ. The effect of fiber post presence and restorative technique on the biomechanical behavior of endodontically treated maxillary incisors: An in vitro study. J Prosthet Dent 2012;108:147-57.
3.	Aurélio IL, Fraga S, Rippe MP, Valandro LF. Are posts necessary for the restoration of root filled teeth with limited tissue loss? A structured review of laboratory and clinical studies. Int Endod J 2016;49:827-35.
4.	Zhu Z, Dong XY, He S, Pan X, Tang L. Effect of post placement on the restoration of endodontically treated teeth: A systematic review. Int J Prosthodont 2015;28:475-83.
5.	Al-Omiri MK, Mahmoud AA, Rayyan MR, Abu-Hammad O. Fracture resistance of teeth restored with post-retained restorations: An overview. J Endod 2010;36:1439-49.
6.	Goldfein J, Speirs C, Finkelman M, Amato R. Rubber dam use during post placement influences the success of root canal-treated teeth. J Endod 2013;39:1481-4.
7.	Zahran M, Tharwat Hamed M, Naguib G, Sabbahi D, Tayeb R, Mously H. A survey of knowledge, practices and mishaps in relation to post placement for endodontically treated teeth. J Res Med Dent Sci 2020;8:209-18.
8.	Beltz RE, Torabinejad M, Pouresmail M. Quantitative analysis of the solubilizing action of MTAD, sodium hypochlorite, and EDTA on bovine pulp and dentin. J Endod 2003;29:334-7.
9.	Ricketts DN, Tait CM, Higgins AJ. Tooth preparation for post-retained restorations. Br Dent J 2005;198:463-71.
10.	Karapanou V, Vera J, Cabrera P, White RR, Goldman M. Effect of immediate and delayed post preparation on apical dye leakage using two different sealers. J Endod 1996;22:583-5.
11.	Livada R, Hosn K, Shiloah J, Anderson KM. Management of heat-induced bone necrosis following thermal removal of gutta-percha. Quintessence Int 2018;49:535-42.
12.	Saunders EM, Saunders WP. The heat generated on the external root surface during post space preparation. Int Endod J 1989;22:169-73.
13.	Tjan AH, Abbate MF. Temperature rise at root surface during post-space preparation. J Prosthet Dent 1993;69:41-5.
14.	Dickey DJ, Harris GZ, Lemon RR, Luebke RG. Effect of post space preparation on apical seal using solvent techniques and peeso reamers. J Endod 1982;8:351-4.
15.	Suchina JA, Ludington JR Jr. Dowel space preparation and the apical seal. J Endod 1985;11:11-7.