Comparative Analysis of Post-Endodontic Restoration Designs on Fracture Resistance in Endodontically Treated Premolars
Endodontically treated premolars, postendodontic restoration, fracture outcomes, fiber post, clinical outcomes
AuthorsABSTRACTEndodontically treated premolars exhibit increased susceptibility to fracture due to structural compromise and altered biomechanical behavior. Selection of an appropriate post-endodontic restoration design is therefore critical for enhancing fracture outcomes and long-term clinical success. Though, comparative clinical evidence evaluating fracture outcomes across different restoration designs in premolars remains limited. This retrospective observational cohort study analyzed clinical and radiographic records of endodontically treated premolars restored with different post-endodontic restoration designs. Teeth were categorized into direct composite restorations without posts, fiber post–supported composite core restorations, cast metal post-and-core restorations, and full-coverage or endocrown restorations. Fracture incidence, mean time to fracture, and fracture occurrence were evaluated. Statistical analysis included descriptive statistics, independent samples t-test, correlation analysis, and binary logistic regression to assess associations and predictors of fracture outcomes. A total of 120 endodontically treated premolars were included. Fiber post–supported composite restorations demonstrated the longest mean fracture-free duration and the lowest fracture risk. Direct composite restorations without posts showed the shortest fracturefree longevity, while cast metal post-and-core restorations were associated with increased fracture risk. A significant difference in mean time to fracture was observed between post-retained and non-post-retained restorations. Correlation and regression analyses confirmed restoration design as a significant predictor of fracture occurrence. Post-endodontic restoration design significantly influences fracture outcomes in endodontically treated premolars. Fiber post– supported composite restorations provide superior fracture outcomes and clinical longevity. Restoration strategies incorporating biomechanical reinforcement should be prioritized to minimize fracture risk and improve longterm prognosis.
Keywords:INTRODUCTIONEndodontic therapy is an important part of modern restorative dentistry as it allows saving pulpal and periapical pathology-affected teeth. Even with the high success rates of the modern endodontic treatments, endodontically treated teeth prove to have a higher susceptibility to structural failure in comparison with vital teeth.1 This increased susceptibility to fracture is chiefly explained by loss of large volumes of tooth structure due to caries, access cavity preparation and restorative procedures and altered post-endodontic biomechanical properties of dentin.2,3 Long term success of endodontic treatment is closely linked to the quality and design of the endodontic restoration. Restoration design establishes the distribution of stress in the tooth-restoration complex and is vital in eliminating the risk of fractures and increasing the clinical longevity. 4 •••••••••••••••••••••••••••••••• ejprd.org - Published by Dennis Barber Journals. Barber Ltd. All rights reserved
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