Fabricating a fiber-reinforced post and zirconia core with CAD/CAM technology

Assessment of CAD/CAM Fabrication Technologies for Post and Core Restorations-A Narrative Review

The primary objective of this study is to conduct a comprehensive review of the existing literature that discusses research on post and core restorations, covering aspects such as their composition, manufacturing methods, and clinical effectiveness. The methodology employed in this review encompasses the implementation of a well-defined search strategy, the establishment of criteria for inclusion and exclusion, and the selection of relevant studies to summarize their findings. To gather relevant literature published between 1993 and 2023, the research team conducted separate searches on PubMed, Web of Science, and Embase databases. In total, 168 titles were initially retrieved from these electronic databases. By applying the predefined exclusion criteria, the researchers identified 73 articles that specifically address the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) technologies employed in post and core restorations. These treatments are commonly employed to restore teeth that have received endodontic therapy and subsequently experienced loss of dental structure. The development of computerized technology for the creation of customized posts and cores has emerged as a straightforward and efficient alternative to traditional methods. The review synthesizes papers discussing the techniques and materials involved in CAD/CAM-based construction of post and cores. It explores strategies for restoring endodontically treated teeth, highlighting both direct and indirect approaches. Commonly mentioned materials include zirconia, composite resin, and hybrid ceramics. Despite the limited literature on CAD/CAM post and core procedures, the review emphasizes the necessity of further research to assess long-term outcomes and efficacy. Additionally, it suggests including implications for future research and clinical recommendations to enhance the depth and practical relevance of the review.

Comparative analysis of stress distribution in residual roots with different canal morphologies: evaluating CAD/CAM glass fiber and other post-core materials

BACKGROUND

The selection of post-core material holds significant importance in endodontically treated teeth, influencing stress distribution in the dental structure after restoration. The use of computer-aided design/computer-aided manufacturing (CAD/CAM) glass fiber post-core possesses a better adaptation for different root canal morphologies, but whether this results in a more favorable stress distribution has not been clearly established.

MATERIALS AND METHODS

This study employed finite element analysis to establish three models of post-core crown restoration with normal, oversized, and dumbbell-shaped root canals. The three models were restored using three different materials: CAD/CAM glass fiber post-core (CGF), prefabricated glass fiber post and resin core (PGF), and cobalt-chromium integrated metal post-core (Co-Cr), followed by zirconia crown restoration. A static load was applied and the maximum equivalent von Mises stress, maximum principal stress, stress distribution plots, and the peak of maximum displacement were calculated for dentin, post-core, crown, and the cement acting as the interface between the post-core and the dentin.

RESULTS

In dentin of three different root canal morphology, it was observed that PGF exhibited the lowest von Mises stresses, while Co-Cr exhibited the highest ones under a static load. CGF showed similar stress distribution to that of Co-Cr, but the stresses were more homogeneous and concentrated apically. In oversized and dumbbell-shaped root canal remnants, the equivalent von Mises stress in the cement layer using CGF was significantly lower than that of PGF.

CONCLUSIONS

In oversized root canals and dumbbell-shaped root canals, CGF has shown good performance for restoration of endodontically treated teeth.

CLINICAL RELEVANCE

This study provides a theoretical basis for clinicians to select post-core materials for residual roots with different root canal morphologies and should help to reduce the occurrence of complications such as root fracture and post-core debonding.

Treatment of a severely compromised endodontically treated tooth with a 2-piece premanufactured glass-fiber post: A clinical report

A 2-piece premanufactured glass-fiber post-and-core for a child with a severely compromised endodontically treated tooth to restore dental form, function, and esthetics, is described. A shorter chair time than for the conventional options was needed, and the post provided an adequate biomechanical response with a reduced intracanal cement thickness.

Effect of Various Surface Treatments on the Push-Out Bond Strength of Fiber Posts to Root Dentin

Background This study aimed to evaluate the effect of various surface treatments on the push-out bond strength of fiber posts to root dentin. Methodology A total of 96 single-rooted premolars were decoronated and obturated and post spaces were prepared for 9 mm. The canals were irrigated with 17% ethylenediaminetetraacetic acid followed by distilled water. The samples were divided into the two following groups based on the type of fiber posts used: Group I - glass fiber post (Reforpost size 1) and Group II: quartz fiber post (Quartzix Added Posts number 1). Further, each group was divided into four subgroups based on the surface treatments (A: no treatment (control); B: silanization; C: 4% titanium tetrafluoride (four minutes) followed by silanization; D: sandblasting followed by silanization). After surface treatments, posts were cemented using self-adhesive resin cement (RelyX U200). Three 2 mm thick slices were obtained and push-out tests were done. Failure modes were analyzed under a stereomicroscope. The surface morphology of the posts was analyzed with a scanning electron microscope. Data were analyzed using a one-way analysis of variance. Results Treating the posts with airborne particle abrasion (sandblasting) followed by silanization showed the highest bond strength. The coronal level of the root showed the highest bond strength compared to the middle and apical levels. Adhesive failures between the resin cement and dentin were found to be the highest. Conclusions Sandblasting followed by silanization produced the highest bond strength. The coronal level of the root showed the highest bond strength. Adhesive failures were the highest followed by mixed failures.

Evaluation of a half-digital technique for fabricating customized post-cores: A pilot study

Objectives

The current half-digital post-core fabrication technique can replace the conventional methods; however, it does not consider the impact occlusion has on the digital design. This study proposed a half-digital workflow that integrated intracanal impression with dentition scanning, and evaluated the accuracy of the post-cores fabricated by it.

Methods

Standard models with three extracted teeth (a central incisor, a premolar, and a molar) were prepared. Eight post-cores were fabricated for each tooth by the half-digital technique and eight by the conventional technique as controls. Scanning was performed with a microcomputed tomography system. The volume of the overall space (VOS) between the post and canal wall, the space areas in three standardized sections (A, B, and C), and the apical gap (AG) were calculated and statistically analyzed using two-way analysis of variance. Statistical significance was set at p < 0.05.

Results

The two techniques differed significantly in the VOS (p < 0.05), section B (p < 0.05), and AG (p < 0.05) of all three teeth but not for sections A (p = 0.099) and C (p = 0.636).

Conclusions

The half-digital technique investigated in this study could produce better-fitting customized post-cores than the conventional technique.

Digital Workflow for Producing Hybrid Posts and Cores

A novel and straightforward digital workflow is described to aid clinicians in producing in-office hybrid posts and cores. The method is based on scanning and using the basic module of a computer-assisted design and computer-assisted manufacturing (CAD-CAM) software program for dental applications. The applicability of the technique in a digital workflow is the simplicity of in-office production of a hybrid post and core that can be delivered to the patient in the same day.

Customized Post and Cores Fabricated with CAD/CAM Technology: A Literature Review

Post and core restorations are a widely accepted method to restore endodontically treated teeth with compromised tooth structure. The use of computerized technology to fabricate customized post and cores is a simple and quick alternative to conventional methods. A literature search was conducted, and a summary of articles describing fabrication techniques and materials used to fabricate post and cores with computer-aided design and computer-aided manufacturing (CAD/CAM) has been provided. Several techniques have been reported to restore endodontically treated teeth with CAD/CAM post and cores, including direct and indirect methods. Zirconia, composite resin, and hybrid ceramic were the most commonly reported materials. Published reports on CAD/CAM post and core are limited; however, further studies are needed to investigate the long-term outcome of this treatment.

In vitro Results of Scanning Technique on Assessing Cement Thickness and Interfacial Nanoleakage of Luted CAD/CAM-Fabricated Fiber Posts

Background:

Fiber posts are broadly used due to their good esthetics and elasticity close to that of dentin, which allows for uniform stress distribution within a root and lowers the possibility of nonrestorable root fractures.

Aim and Objectives:

The study assessed the layer of cement thickness and interfacial nanoleakage of luted fiber posts which were fabricated with CAD/CAM technology following direct scanning of the post space (DS) method, scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS).

Methodology:

Ninety premolars were chosen randomly and were assigned to three groups according to the scanning technique. Posts were computer designed and milled from experimental fiber-reinforced composite blocks.

Results:

The mean and standard deviation values of cement thickness, respectively, were: DS 172 ± 39 = m; IS 199 ± 55 = m, and MS MPa 272 ± 81 = m. The fiber posts fabricated following DS technique demonstrated superior performance compared to posts fabricated upon IS and MS, in terms of the post retention. The cement thickness did not differ between DS and IS, whereas in MS group, the cement layer was significantly thicker than in the remaining two groups. The scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage.

Conclusion:

Fiber posts fabricated following DS technique demonstrated superior performance. Furthermore, scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage.

CAD/CAM Customized Glass Fiber Post and Core With Digital Intraoral Impression: A Case Report

Background

After endodontic treatment, a proper restorative technique is necessary to ensure coronal seal and protection of residual dental structure; teeth which have lost two or more walls need to be restored with posts to increase retention and stability of final restoration. Posts can be distinguished in prefabricated and customized, which are manufactured by lost wax technique or CAD-CAM.

Purpose

Digital dentistry has been developed to increase workflow precision and to accelerate production process; use of CAD-CAM to realize customized posts was limited to scanning plaster models obtained from traditional impressions.

Patients and Methods

In the reported case an intraoral scan was used to mill a post and core restoration on an endodontically treated inferior premolar; this operative protocol was based on previous in vitro experiments that confirmed the ability of 3shape Trios scanner to read post-space up to 9 mm in depth.

Results

The digital technique allows us to convert the concave surface of the root canal into the convex surface of the post, and realize an anatomical post and core that improves the biomechanics of the endodontically treated tooth reducing the possibility of root fractures.

Conclusion

The use of an intraoral digital scanner represents an opportunity for the clinician as it speeds up the production of an anatomical post and core restorations.

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Effects of scanning technique on in vitro performance of CAD/CAM-fabricated fiber posts

This study assessed push-out strength, cement layer thickness, and interfacial nanoleakage of luted fiber posts fabricated with computer-aided design/computer-assisted manufacture (CAD/CAM) technology after use of 1 of 3 scanning techniques, namely, direct scanning of the post space (DS), scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS). Thirty premolars were randomly assigned to three groups corresponding to the scanning technique. Posts were computer-designed and milled from experimental fiber-reinforced composite blocks. The mean (±SD) values for push-out strength and cement thickness were 17.1 ± 7.7 MPa and 162 ± 24 μm, respectively, for DS, 10.7 ± 4.6 MPa and 187 ± 50 μm for IS, and 12.0 ± 7.2 MPa and 258 ± 78 μm for MS specimens. Median (interquartile range) interfacial nanoleakage scores were 3 (2-4) for DS, 2.5 (2-4) for IS, and 3 (2-4) for MS. Post retention was better for fiber posts fabricated by DS technique than for those fabricated by IS and MS. Cement thickness did not differ between DS and IS specimens, but the cement layer was significantly thicker in the MS group than in the other two groups. Scanning technique did not affect sealing ability, as the three groups had comparable nanoleakage values.

In vitro evaluation of the post-space depth reading with an intraoral scanner (IOS) compared to a traditional silicon impression

Objectives

The aim of the study was to assess the depth and quality of the post-space reading, using an IOS without scan-post, compared to a traditional silicon technique.

Methods

Six extracted bicuspids were decoronated and endodontically treated. After having prepared the space for the posts, a structure in pink acrylic resin was created with two resin elements. At the center of the structure one sample was put at a time. Digital and traditional impressions were taken for each sample.Digital impressions were developed through the Computer-aided design (CAD) software in order to integrate the scanner results into a three-dimensional grid to make the measurements. A K-file was used to measure the length of the post-space of each sample obtained through the traditional silicon impression and subsequently the measurement results were reported on a millimeter gauge. Furthermore, an assessment of the width of the entrances of the post-spaces was carried out.

Results

The mean reading depth discrepancy expressed in percentages (19.58%) indicates that the digital impression with current technologies fails to impress clearly the post-space. Standard deviation of the data expressed in percentage is 13.89, suggesting that the values were not similar to each other. In two cases the digital technique has achieved less than 10% difference compared to the traditional technique, but there have been also cases in which the variation in depth has reached almost 40%.The samples that showed the minor discrepancy between the two techniques expressed the widest post-space entrance.

Conclusions

In this in vitro study, the application of the IOS for the post-space reading in order to deliver an anatomic post has been proven to be still not reliable, as there are still depth reading limitations for the narrow root channels. In fact, in this type of channels it is difficult to reach with the light beam of the IOS the deepest areas of the post-space, with a consequent incomplete post-space reading.

Accelerated techniques for a post and core and a crown restoration with intraoral digital scanners and CAD/CAM and rapid prototyping

Fabricating a post-and-core and a crown restoration for an endodontically treated tooth with extensive loss of tooth structure is complicated, difficult, and time consuming. This article describes 2 techniques for fabricating an anatomically correct ceramic core with fewer defects and a crown restoration with appropriate thickness by using intraoral digital scanners and computer-aided design and computer-aided manufacturing and rapid prototyping technologies.