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The restoration of endodontically treated, single-rooted teeth with cast or
direct posts and cores: A systematic review
Guido Heydecke, DDS, Dr Med Dent,a and Mathilde C. Peters, DDS, PhDb
School of Dentistry, University of Michigan, Ann Arbor, Mich.
Direct post-and-core restorations with prefabricated posts are becoming increasingly popular. A literature
review was conducted to compare theclinical and in vitro performance of cast posts and cores to that of
direct cores with prefabricated posts in single-rooted teeth. Research on the restoration of endodontically
treated teeth was identified through a search of electronic databases. The search yielded a total of 1773
references. After these references were subjected to strict inclusion criteria, 10 in vitro and 6 in vivo studiesremained and critically reviewed. A comparison of fracture loads in the in vitro studies revealed no
significant difference between cast and direct posts and cores. Meta-analysis of the data suggested that
there is no difference in fracture behavior associated with the 2 treatment modalities. An overall survival
analysis was not possible for the in vivo studies. The survival for cast posts andcores in 2 studies ranged
from 87.2% to 88.1% and in a third study reached 86.4% for direct cores after 72 months. Randomized
clinical trials on this topic were not available but should be conducted to verify published findings. (J
Prosthet Dent 2002;87:380-6.)

T

he dental practitioner is often faced with the task
of restoring endodontically treated teeth. Root canal
treatment isusually the consequence of caries followed
by pulpal infection or traumatic damage to a tooth.
Trauma and decay are mostly associated with an extensive loss of tooth structure, necessitating restoration of
the tooth with a complete crown for esthetic and functional rehabilitation. When a large portion of the
clinical crown has been lost to damage, it often is
impossible to achieve sufficientanchorage of a restoration in the remaining dentin. In such situations, a
root-canal–retained restoration is required.1
In molars, the use of post-retained cores is often
unnecessary due to sufficient dentin bulk and axial
loading conditions. Because single-rooted teeth (especially incisors) are loaded nonaxially, more stress
develops when chewing forces are exerted.2 Thus, the
cast post-and-coreprocedure has been advocated as
the gold standard restoration for decades. Since the
introduction of the direct post-and-core restoration,3
associated techniques and materials have improved significantly.4 Posts and cores also have been proposed
for the stabilization of weakened, endodontically treated teeth. While paradigms are shifting for the
restoration of otherwise sound non-vital teeth,alternatives to the cast post and core have not yet enjoyed
widespread clinical use.5,6
Different approaches can be taken to the fabrication
of cast posts and cores. Burn-out plastic patterns or

aVisiting

Assistant Professor, Department of Biologic and Materials
Sciences.
bProfessor, Department of Cariology, Restorative Sciences, and
Endodontics, University of Michigan School ofDentistry.
380 THE JOURNAL OF PROSTHETIC DENTISTRY

cast-on posts can be fitted to the root canal and then
relined with autopolymerizing acrylic. A core pattern
can then be built up from autopolymerizing acrylic
and subsequently cast in dental alloy. As an alternative,
direct restorative procedures are also available.
Preformed titanium, stainless steel, or (more recently)
carbon-fiber andzirconia posts have been advocated
for the buildup of pulpless teeth. The posts are bonded to the tooth, and the actual core is built up from
amalgam, cement, or a hybrid composite.4,7
While an abundance of in vitro studies on different
aspects of post-and-core restorations has been reported in the literature, few studies compare the success of
clinically meaningful restorative approaches....