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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 95-98

A study to evaluate the preferences of dentists for the materials chosen to restore endodontically treated teeth and the influence of both clinical experience and level of specialization on the dentist's choice of posts


1 Reader, Department of Prosthodontics Crown and Bridge, Subbaiah Institue of Dental Sciences, Shivamogga, Karnataka, India
2 Assistant Professor, Department of Dental and Implant Surgery, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
3 Assistant Professor, Department of Conservative and Endodontics, Subbaiah Institue of Dental Sciences, Shivamogga, Karnataka, India
4 Professor, Department of Prosthodontics Crown and Bridge, Subbaiah Institue of Dental Sciences, Shivamogga, Karnataka, India
5 Assistant Professor, Department of Prosthodontics Crown and Bridge, Subbaiah Institue of Dental Sciences, Shivamogga, Karnataka, India
6 Associate Professor, Department of Prosthodontics Crown and Bridge, Subbaiah Institue of Dental Sciences, Shivamogga, Karnataka, India

Date of Submission17-Dec-2022
Date of Acceptance19-Dec-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Arun Kumar Talkal
House No F-6, Staff Quarters, B Block, Subbaiah Institute of Dental Sciences, Holehonnur Road, Shivamogga - 577 222, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_25_22

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  Abstract 


Background: In endodontics, dentist's choice for using posts/materials relevant to posts used to restore endodontic-treated teeth is influenced by clinical experience, whether concerning the length of practice time and level of specialization.
Objective: Traditional restorative approaches are being modified as newer materials become available and patient preferences shift. The purpose of the study was to see if dentists' preferences for using posts and other materials associated to post used to restore endodontically treated teeth are influenced by practical experience, whether measured by the length of clinical practice time or level of specialty.
Methodology: A cross-sectional study was conducted with dentists (n = 100) working in Karnataka utilizing a questionnaire. Data on sociodemographics, clinical experience, postgraduate training, and postendodontic restoration characteristics (posts/types of cement and rubber dam application) were obtained. The samples only included general and specialist dentists. A descriptive analysis was performed on the data. The Chi-square test and Fisher's exact test investigated the relationships.
Results: The most chosen materials were metal posts (60%) and resin cement (70%). There was a statistically significant association between clinical practice duration and postuse type (P = 0.017). In addition, there was a highly significant relationship (P = 0.001) between clinical practice time, level of specialty, and the use of rubber dams.
Conclusions: Dentists favored metal posts for post endodontic restorations, while resin-based cement was the preferred luting cement for the posts' cementation. Additional training and more clinical practice time were factors in several dental postselection decisions.

Keywords: Endodontic restoration, fiber post, metal post, rubber dam


How to cite this article:
Talkal AK, Prajapati UH, Shashank S N, Swamy MC, Patil H G, Reddy MK. A study to evaluate the preferences of dentists for the materials chosen to restore endodontically treated teeth and the influence of both clinical experience and level of specialization on the dentist's choice of posts. Int J Prev Clin Dent Res 2022;9:95-8

How to cite this URL:
Talkal AK, Prajapati UH, Shashank S N, Swamy MC, Patil H G, Reddy MK. A study to evaluate the preferences of dentists for the materials chosen to restore endodontically treated teeth and the influence of both clinical experience and level of specialization on the dentist's choice of posts. Int J Prev Clin Dent Res [serial online] 2022 [cited 2023 Feb 6];9:95-8. Available from: https://www.ijpcdr.org/text.asp?2022/9/4/95/366148




  Introduction Top


The management of pulp conditions is known as endodontic treatment. It is generally intended to maintain or restore the health of the dental pulp and periradicular tissues by filling or blocking all root canals and forming a fluid-tight seal on the apical foramen of the tooth to prevent secondary infection from the mouth cavity or periradicular tissue leakage into the root canal system.[1],[2] To restore endodontically treated teeth, various materials, and procedures are currently available. Past restorative practices are updated as newer materials emerge and patient preferences change.[3] A post is routinely put into the root canal system to retain the core in a badly traumatized tooth. The goal of postplacement is to keep the core foundation intact. Its purpose is not to strengthen a tooth with a root canal.[4] For restoring endodontic-treated teeth, there are a variety of post and cement options. There is a wide range of techniques that use various types of metal posts and cores and the newer fiber-reinforced polymer post.[5],[6],[7],[8] Several factors, including factors related to posts and factors associated with teeth, have been observed to influence postselection and restoration durability. Material, esthetics, design, and cementing procedures are all factors to consider regarding post selection. However, surviving coronal tooth structure, ferrule existence, and the root length are the characteristics associated with teeth.[9],[10],[11],[12] Dentists must be trained and have up-to-date expertise when new materials are introduced. Several studies have been published concerning the knowledge and practices of postendodontic restoration abroad. However, there is a lack of such studies in India. The objective of this research was to see if a dentist's choice for using posts/materials relevant to posts used to restore endodontic-treated teeth is influenced by clinical experience, whether concerning the length of practice time and level of specialization among dentists in Karnataka, India.


  Methodology Top


A cross-sectional survey of registered dentists was conducted in India. A total of 100 dentists were invited to take part in the research. A self-applied closed survey was designed to collect data. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. The following details were gathered: clinical experience (years following graduation, classified as 0–4 years, 5–9 years, and 10 years), level of specialization (BDS, MDS degree), and divided into general dentist and specialist. The following data were obtained on the frequency of root canals treated per week, the need for postplacement in every endodontic treated tooth, postinsertion frequency, and post usage to restore root canal treated teeth. The most commonly utilized post (metal or fiber post), the cement used to lute these posts (glass ionomer cement, resin cement, or zinc phosphate cement), and the application of a rubber dam (yes or no). There was no information in the data that could be used to identify the dentist. Each dentist who was asked to participate in the study at the college of dentistry received the questionnaire in person. The significance of the study and its details were explained. Only dentists with a Bachelor's or Postgraduate degree were included in the study. The undergraduates were not included in the research.

Statistical analysis

The descriptive analyses were calculated as absolute frequencies and good percentages. The Chi-square test and Fisher's exact test were used to assess the existing relationship between postgraduate education, professional experience, and dentist preferences (type of post/cement use and rubber dam application). The significance level was adjusted at (P = 0.05). SPSS software version 23 was used for the analysis (SPSS Inc., Chicago, Illinois, USA).


  Results Top


The mean ± standard deviation (32.1 ± 5.7) of the dentists' ages was calculated using descriptive statistics. The respondents included 50% general dentists and 50% specialist, dentists. It is revealed in that the number of root canal treatments carried out per week by the 56% dentists was mostly around 5–9. The results in 67% of general dentists and specialists both widely thought that for every root canal-treated tooth, a post was unnecessary. Sixty percent of the surveyed dentists chose metal post as the preferred technique for restoring endodontic treated teeth, while 40% of the dentists chose fiber post as the preferred technique for restoring endodontic-treated teeth. Regarding the type of luting cement, result shows that 70% of the dentists selected resin cement as the preferred luting cement. Eighty percent dentists who participated in this study reported not using the rubber dam as shown in [Figure 1]. There was a statistically significant association between clinical practice time and type of postuse where it is evident in that the use of fiber post among dentists who had clinical experience 5–9 years (70%) was significantly higher than the use of fiber posts among the dentists who had clinical experience 0–4 years (10%) and 10 or more than 10 years (20%) (P = 0.015) as shown in [Table 1]. There was no significant association between clinical practice time and type of luting cement use (P > 0.05).
Figure 1: Dentist and usage of Rubber Dam

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Table 1: Association between the length of clinical practice time and type of postuse

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  Discussion Top


This study's findings matched those of research conducted in Saudi Arabia,[13] Palestine,[14] Switzerland,[15] and Brazil on postendodontic restorations, where metal posts were more commonly used. Due to its higher advantages, lower risk of tooth damage, and likeness to dentin, it is better to raise awareness and shift dentists' attitudes about employing fiber posts more often than metal posts. There is, however, no evidence to support the “optimal technique” to restore a tooth that has been root canal treated. When determining the type of post to utilize in restoring endodontically treated tooth (ETT), numerous aspects should be considered, including intact coronal structure, ferrule availability, and post material.[12] Indeed in root endodontically teeth, maintaining at least one wall ensures greater tooth longevity.[10] In this study, most dentists favored resin cement over lute posts (50%). In 2015, Sarkis-Onofre et al.[13] showed similar findings to the present study where the preferred luting cement was also seen as resin cement. In contrast, Rabi TH.[14] sought that the preferred choice of luting cement among dentists was glass ionomer cement. The long-term clinical performance of the various cement used for post cementation is hardly understood.[14] Zinc phosphate has the longest track record of success. It is well-suited with zinc oxide eugenol, which is incorporated in most root canal sealers and has a long working duration. Furthermore, when an endodontic failure occurs, a metal post cemented in the root canals with zinc phosphate is easier to remove and has a reduced risk of root fracture than a metal post cemented in the root canal space with resin-based composite cement.[16] However, our findings contradicted the literature because zinc phosphate was the least popular luting cement among the respondents (11.1%); this is most likely due to dentists' lack of understanding of the benefits of utilizing zinc phosphate for post cementation.[16] Metal posts, glass ionomer, and nonuse of rubber dam were used more frequently by dentists with less practical clinical experience (time since graduation) (0–4 years) than dentists with more time since graduation. At the same time, those with more practical clinical experience (time after graduation) tend to utilize fiber posts, resin cement, and rubber dam more than the general dental practitioners. There was a link between clinical practice time, postuse type, and rubber dam application. Those who graduated a while ago used the rubber dam more frequently to restore a root canal-treated tooth. These findings may be because those who have graduated a while ago may have had some kind of postgraduation training or attended continuing education courses, suggesting that they are more likely to be exposed to new techniques.[1],[2],[3],[4],[17] When it comes to postgraduate education, the evidence suggests that dental specialists are better informed with the literature and attend meetings more frequently, directly influencing their clinical decisions and, as a result, their practices. These dentists are better equipped to incorporate new technology into their clinical practice.However, there was no significant relationship between the level of expertise and the type of post used in this investigation. This study revealed that postgraduate dentists are more likely to use metal supports to restore root canal-treated teeth. However, an almost equal number of fiber posts to metal posts were registered. A similar finding was seen in a study carried out in Saudi Arabia.[14] The previous research found that specialist dentists selected fiber posts as their first option for restoring endodontic-treated teeth, while nonspecialists preferred metal posts.[13],[14],[18],[19] The results or findings of the present study may be due to the geographical region and the cost of fiber posts. Many dentists whether specialists or nonspecialists may know the importance of using a fiber post but refuse to use it because it is more expensive than the metal post. Furthermore, some dentists claim that they face more problems when using fiber posts because of the chance of debonding. However, they may find the metal post preferable because if the metal post is tightly screwed within the root canal and is cemented well, they will not suffer from replacing the posts. There was a highly significant association between the level of specialization and rubber dam use in this study. In contrast to specialized dentists, more than half of the general dentists did not use a rubber dam to isolate the operative field during a post insertion to restore a root canal-treated tooth; this could be because, as an undergraduate student were not taught to apply and use the rubber dam in clinical situations. Specialists with some postgraduate education, on the other hand, were taught the importance of utilizing a rubber dam for any restoration of an ETT during their training. The findings of this study are consistent with those of questionnaire-based studies undertaken in another country. According to a study, applying a rubber dam during prefabricated postplacement considerably enhances the chances of teeth with endodontic management. Because it relied on a self-administered applied closed questionnaire, this study has several limitations. The downside was that the respondents did not always answer all of the questionnaire's questions honestly, and open-ended questions were not permitted.[13] Furthermore, another limitation may be that there was more chance of errors due to the small sample size.


  Conclusions Top


Teeth with substantial coronal damage after root canal therapy may require intracanal posts for retention. The best way to restore endodontically treated teeth is unknown. Various aspects such as the type of coronal restoration, the extent of residual coronal structure, the type of luting agent, and dentist-related factors should all be considered into account. Correlating practice, knowledge, and scientific interpretation have been identified as the most effective way of resolving selection issues, and it may be adopted quickly and effectively in clinical practice. Overall, the study's findings revealed that most dentists do not believe that every root canal-treated tooth requires a post. Metal posts were the preferred type of post used for post endodontic restorations, and the resin-based cement dominated as the preferred luting cement for cementation of the posts. Continuing education and more clinical practice experience influenced some of the choices about which dental posts to select and other postrelated materials such as luting cement and rubber dam.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ratnakar P, Bhosgi R, Metta KK, Aggarwal K, Vinuta S, Singh N. Survey on restoration of endodontically treated anterior teeth: A questionnaire based study. J Int Oral Health 2014;6:41-5.  Back to cited text no. 1
    
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Schwartz RS, Robbins JW. Post placement and restoration of endodontically treated teeth: A literature review. J Endod 2004;30:289-301.  Back to cited text no. 4
    
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Sarkis-Onofre R, Jacinto RC, Boscato N, Cenci MS, Pereira-Cenci T. Cast metal versus. Glass fibre posts: A randomized controlled trial with up to 3 years of follow up. J Dent 2014;42:582-7.  Back to cited text no. 8
    
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Goracci C, Ferrari M. Current perspectives on post systems: A literature review. Aust Dent J 2011;56 Suppl 1:77-83.  Back to cited text no. 9
    
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Faria-e-Silva AL, Mendonça AA, Garcez RM, Oliveira Ada S, Moreira AG, Moraes RR. Adhesion strategy and early bond strengths of glass-fiber posts luted into root canals. Braz Oral Res 2012;26:485-7.  Back to cited text no. 10
    
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Santos Filho PC, Soares PV, Reis BR, Veríssimo C, Soares CJ. Effects of threaded post placement on strain and stress distribution of endodontically treated teeth. Braz Oral Res 2013;27:305-10.  Back to cited text no. 11
    
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Sarkis-Onofre R, Pereira-Cenci T, Opdam NJ, Demarco FF. Preference for using posts to restore endodontically treated teeth: Findings from a survey with dentists. Braz Oral Res 2015;29:1-6.  Back to cited text no. 12
    
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Eckerbom M, Magnusson T. Restoring endodontically treated teeth: A survey of current opinions among board-certified prosthodontists and general dental practitioners in Sweden. Int J Prosthodont 2001;14:245-9.  Back to cited text no. 13
    
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Rabi TH. Attitudes of Palestinian dentists toward restoration of endodontically treated teeth. Int J Prosthodont Restor Dent 2015;5:44-50.  Back to cited text no. 14
    
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Kavlekar AA, Aras MA, Chitre V. Treatment concepts for restoration of endodontically treated teeth: A survey among general practitioners, prosthodontists, and endodontists in India. J Contemp Dent 2016;6:129-36.  Back to cited text no. 15
    
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Cheung W. A review of the management of endodontically treated teeth. Post, core and the final restoration. J Am Dent Assoc 2005;136:611-9.  Back to cited text no. 16
    
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Nagasiri R, Chitmongkolsuk S. Long-term survival of endodontically treated molars without crown coverage: A retrospective cohort study. J Prosthet Dent 2005;93:164-70.  Back to cited text no. 17
    
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Akbar I. Knowledge, attitudes and practice of restoring endodontically treated teeth by dentists in North of Saudi Arabia. Int J Health Sci (Qassim) 2015;9:41-9.  Back to cited text no. 18
    
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Kon M, Zitzmann NU, Weiger R, Krastl G. Postendodontic restoration: A survey among dentists in Switzerland. Schweiz Monatsschr Zahnmed 2013;123:1076-88.  Back to cited text no. 19
    


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