Authors' objectives:

The aim of this review is to define the indications and contraindications for two types of restoration for nonvital teeth - indirect post-and-core (IPC) and direct plastic filling (DPF) - on the basis of an assessment of safety and efficacy.

Authors' recommendations: (i) Description. The aim of a restoration of an endodontically-treated tooth is to provide retention for the coronal restoration, i.e. a crown, bridge abutment, or support for partial denture. (ii) Selected studies. Two meta-analyses and 6 poorly designed clinical trials were identified but did not provide sufficient evidence for establishing indications. Despite the poor evidence, the working group did, however, propose contraindications, together with a list of factors to be taken into account when deciding on which technique to use. (iii) Preliminary considerations. The working group emphasised that: -Dentine must always be preserved, particularly in the cervical area. -Any technique involving bonding requires a dry operative field. -A post is not always required for a restoration of a nonvital tooth. (iv) Contraindications. An IPC is contraindicated if a post offers no benefit or cannot be used. DPF buildup restorations are contraindicated: - if there is less than 2 mm sound dentine coronal to the proposed crown margin; - if the mechanical resistance of the restoration is inadequate for the intended occlusal loading. (v)Key factors in deciding which restoration method to use. A decision algorithm is not possible as the relative weight of each factor cannot be established outside the clinical situation. The factors have no clinical relevance when taken in isolation. (a) Ratio between mechanical resistance and restoration volume: - Residual tooth volume is assessed after the margin has been prepared. - A threshold value for loss of substance that would indicate one technique rather than the other cannot be defined without knowing the clinical context. - When there is major loss of dentine, an IPC will provide better integrity of the restored tooth. (b) Functional considerations: - Position of the tooth on the arch: Given the alignment of the roots of the anterior maxillary teeth, if the loss of dentine requires a post, an IPC is indicated or strongly recommended; - The occlusion: An IPC is indicated or strongly recommended if the unfavourable occlusion leads to major stresses of the restored tooth in excursive movements; - The intended role of the restoration (crown, bridge abutment, or partial denture abutment): If there is average or major loss of substance, direct DPF buildup restorations are contraindicated when a tooth will be used as a partial denture abutment or bridge abutment, because mechanical resistance will be inadequate. (c) Anatomy of the root: When the shape of the root does not allow a sufficiently retentive post to be inserted, a DPF buildup restoration using a bonded and/or passively screwed and cemented post is indicated as a last resort. (vi) Other factors in deciding which restoration method to use. (a) Patient-related factors (limited access to the mouth, difficulty holding the mouth open): DPF buildup restorations require a long, uninterrupted clinical appointment and easy access to the operative site. When these conditions cannot be met, an ICP is better. (b) Retreatment: Use of a post makes retreatment through the crown difficult, and the possibility of retreatment should not be relied on. Retreatment is easier with a DPF buildup restoration using a luted metal post.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr

Copyright: Haute Autorite de Sante/French National Authority for Health (HAS)