One-Year Clinical Comparison of Survival of Endodontically Treated Premolar Restored with Different Direct Restoration Technique: A Prospective Cohort Study


1 Assistant Professor, Dental Research Center, Department Operative DentistryMashhad University of Medical Sciences,Mashhad, Iran

2 School of Dentistry,Mashhad University of Medical Sciences,Mashhad, Iran

3 Associated Professor of Restorative Dentistry, Center of Excellence inMedical Education Technology,Mashhad University of Medical Sciences,Mashhad, IR Iran


Abstract Background: Endodontically treated teeth need to be restored in amanner to provide protection for the remaining tooth structure but would also allow the restoration of esthetic and functional demands. Objectives: This study evaluates the clinical success rate of endodontically treated premolars restored with different techniques. Methods: In this study, 96 participants were included with indication of endodontic treatment of one maxillary or mandibular premolar. Only cases with premolars along with MOD Class II carious lesions and preserved cusp structure were recruited. After endodontic treatment subjects were randomly assigned to one of the following restoration methods: (1) composite restoration without any cusp reduction(2)Composite associatedwithafiber reinforced composite (FRC) post (3) capping the buccal and lingual cusp and composite restoration. Subjectswere recalled for the clinical and radiographical evaluationswithmodifiedUSPHS criteria after three, six and 12months. Results: During the evaluation period, all the threemethods of restoration, achieved the Alpha degree in termof modified USPHS criteria. Conclusions: The clinical success rates of endodontically treated premolars restoredwith fiber posts and direct composite restora- tions, direct composite restorationswithcuspcapping andsimpledirect composite restorationwereperfect after one year of follow- up evaluation.


  1. 1.Lovdahl PE, Nicholls JI. Pin-retained amalgam cores vs. cast-gold dowel-cores. J Prosthet Dent. 1977;38(5):507–14. doi: 10.1016/0022- 3913(77)90025-7. [PubMed: 335051].

    1. Rud J, Omnell KA. Root fractures due to corrosion. Diagnostic aspects. Scand J Dent Res. 1970;78(5):397–403. doi: 10.1111/j.1600- 0722.1970.tb02088.x. [PubMed: 5275851].
    2. Tamse A, Fuss Z, Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod. 1999;25(7):506–8. doi: 10.1016/S0099-2399(99)80292-1. [PubMed: 10687518].
    3. Oskoee SS, Oskoee PA, Navimipour EJ, Shahi S. In vitro fracture resistance of endodontically-treated maxillary premolars. Oper Dent. 2007;32(5):510–4. doi: 10.2341/06-149. [PubMed: 17910229].
    4. Santos MJ, Bezerra RB. Fracture resistance of maxillary premolars restored with direct and indirect adhesive techniques. J Can Dent Assoc. 2005;71(8):585. [PubMed: 16202199].
    5. van Dijken JW. Direct resin composite inlays/onlays: an 11 year followup. J Dent. 2000;28(5):299–306. doi: 10.1016/S0300-5712(00)00010-5. [PubMed: 10785294].
    6. Hansen EK, Asmussen E. In vivo fractures of endodontically treated posterior teeth restored with enamel-bonded resin. Endod Dent Traumatol. 1990;6(5):218–25. doi: 10.1111/j.1600-9657.1990.tb00422.x. [PubMed: 2133313].
    7. Hajizadeh H, Namazikhah MS, Moghaddas MJ, Ghavamnasiri M, Majidinia S. Effect of posts on the fracture resistance of load-cycled endodontically-treated premolars restored with direct composite resin. J Contemp Dent Pract. 2009;10(3):10–7. [PubMed: 19430621].
    8. Mannocci F, Ferrari M, Watson TF. Intermittent loading of teeth restored using quartz fiber, carbon-quartz fiber, and zirconium dioxide ceramic root canal posts. J Adhes Dent. 1999;1(2):153–8. [PubMed: 11725680].
    9. D’Arcangelo C, De Angelis F, Vadini M, Zazzeroni S, Ciampoli C, D’Amario M. In vitro fracture resistance and deflection of pulpless teeth restored with fiber posts and prepared for veneers. J Endod. 2008;34(7):838–41. doi: 10.1016/j.joen.2008.03.026. [PubMed: 18570991].
    10. Kishen A, Asundi A. Photomechanical investigations on post endodontically rehabilitated teeth. J Biomed Opt. 2002;7(2):262–70. doi: 10.1117/1.1463046. [PubMed: 11966313].
    11. Qualtrough AJ, Mannocci F. Tooth-colored post systems: a review.Oper Dent. 2003;28(1):86–91. [PubMed: 12540124].
    12. Soares CJ, Soares PV, de Freitas Santos-Filho PC, Castro CG, Magalhaes D, Versluis A. The influence of cavity design and glass fiber posts on biomechanical behavior of endodontically treated premolars. J Endod. 2008;34(8):1015–9. doi: 10.1016/j.joen.2008.05.017. [PubMed: 18634938].
    13. Cagidiaco MC, Garcia-Godoy F, Vichi A, Grandini S, Goracci C, Ferrari M. Placement of fiber prefabricated or custom made posts affects the 3-year survival of endodontically treated premolars. Am J Dent. 2008;21(3):179–84. [PubMed: 18686771].
    14. Ferrari M, Cagidiaco MC, Goracci C, Vichi A, Mason PN, Radovic I, et al. Long-term retrospective study of the clinical performance of fiber posts. Am J Dent. 2007;20(5):287–91. [PubMed: 17993023].
    15. Nam SH, Chang HS, Min KS, Lee Y, Cho HW, Bae JM. Effect of the number of residual walls on fracture resistances, failure patterns, and photoelasticity of simulated premolars restored with or without fiber-reinforced composite posts. J Endod. 2010;36(2):297–301. doi: 10.1016/j.joen.2009.10.010. [PubMed: 20113794].
    16. Barfeie A, Thomas MB, Watts A, Rees J. . Failure Mechanisms of Fibre Posts: A Literature Review. EuropeanJ Prosthodontics Restorative Dentist. 2015;23(3):115–27.
    17. Mackenzie DF. The reinforcing effect of mesio-occlusodistal acidetch composite restorations on weakened posterior teeth. Br Dent J. 1986;161(11):410–4. doi: 10.1038/sj.bdj.4805991. [PubMed: 3466621].
    18. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent. 2002;87(3):256–63. doi: 10.1067/mpr.2002.122014. [PubMed: 11941351].
    19. Naumann M, Blankenstein F, Kiessling S, Dietrich T. Risk factors for failure of glass fiber-reinforced composite post restorations: a prospective observational clinical study. EurJ Oral Sci. 2005;113(6):519– 24. doi: 10.1111/j.1600-0722.2005.00257.x. [PubMed: 16324143].
    20. Fokkinga WA, Le Bell AM, Kreulen CM, Lassila LV, Vallittu PK, Creugers NH. Ex vivo fracture resistance of direct resin composite complete crowns with and without posts on maxillary premolars. Int Endod J. 2005;38(4):230–7. doi: 10.1111/j.1365-2591.2005.00941.x. [PubMed: 15810973].
    21. Krejci I, Duc O, Dietschi D, de Campos E. Marginal adaptation, retention and fracture resistance of adhesive composite restorations on devital teeth with and without posts. Oper Dent. 2003;28(2):127–35. [PubMed: 12670067].
    22. Siso SH, Hurmuzlu F, Turgut M, Altundasar E, Serper A, Er K. Fracture resistance of the buccal cusps of root filled maxillary premolar teeth restored with various techniques. Int Endod J. 2007;40(3):161–8. doi: 10.1111/j.1365-2591.2007.01192.x. [PubMed: 17305692].
    23. Assif D, Gorfil C. Biomechanical considerations in restoring endodontically treated teeth. J Prosthet Dent. 1994;71(6):565–7. [PubMed: 8040817].
    24. Cailleteau JG, Rieger MR, Akin JE. A comparison of intracanal stresses in a post-restored tooth utilizing the finite element method. J Endod. 1992;18(11):540–4. doi: 10.1016/S0099-2399(06)81210-0. [PubMed: 1298790].
    25. Van Meerbeek B. Dentin/enamel bonding. J Esthet Restor Dent. 2010;22(3):157. doi: 10.1111/j.1708-8240.2010.00329.x. [PubMed: 20590966].
    26. Ausiello P, De Gee AJ, Rengo S, Davidson CL. Fracture resistance of endodontically-treated premolars adhesively restored. Am J Dent. 1997;10(5):237–41. [PubMed: 9522698].
    27. Dalpino PH, Francischone CE, Ishikiriama A, Franco EB. Fracture resistance of teeth directly and indirectly restored with composite resin and indirectly restored with ceramic materials. Am J Dent. 2002;15(6):389–94. [PubMed: 12691276].
    28. de Freitas CR, Miranda MI, de Andrade MF, Flores VH, Vaz LG, Guimaraes C. Resistance to maxillary premolar fractures after restoration of class II preparations with resin composite or ceromer. Quintessence Int. 2002;33(8):589–94. [PubMed: 12238690].
    29. Yamada Y, Tsubota Y, Fukushima S. Effect of restoration method on fracture resistance of endodontically treatedmaxillary premolars. Int J Prosthodont. 2004;17(1):94–8. [PubMed: 15008239].
    30. Brunton PA, Cattell P, Burke FJ,Wilson NH. Fracture resistance of teeth restored with onlays of three contemporary tooth-colored resinbonded restorative materials. J Prosthet Dent. 1999;82(2):167–71. doi: 10.1016/S0022-3913(99)70151-4. [PubMed: 10424979].
    31. Lertchirakarn V, Palamara JE, Messer HH. Patterns of vertical root fracture: factors affecting stress distribution in the root canal. J Endod. 2003;29(8):523–8. doi: 10.1097/00004770-200308000-00008. [PubMed: 12929700].
    32. Toparli M. Stress analysis in a post-restored tooth utilizing the finite element method. J Oral Rehabil. 2003;30(5):470–6. doi: 10.1046/j.1365- 2842.2003.01090.x. [PubMed: 12752925].
    33. Mohammadi N, Kahnamoii MA, Yeganeh PK, Navimipour EJ. Effect of fiber post and cusp coverage on fracture resistance of endodontically treated maxillary premolars directly restored with composite resin. J Razavi Int J Med. 2016; 4(4):e39800. 5 Akbari M et al. Endod. 2009;35(10):1428–32. doi: 10.1016/j.joen.2009.07.010. [PubMed: 19801245].
    34. Ferrari M, Cagidiaco MC, Grandini S, De Sanctis M, Goracci C. Post placement affects survival of endodontically treated premolars.J Dent Res. 2007;86(8):729–34. doi: 10.1177/154405910708600808. [PubMed: 17652200].