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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 1  »  Incidence of root fractures and methods used for post removal
Incidence of root fractures and methods used for post removal
Introduction - Materials and methods.



Introduction.
The dental literature contains little information about the removal of posts from teeth that require root canal retreatment. Most of the articles are either case reports or descriptions of various techniques. Many dentists believe that removing posts can lead to root fractures and this appears to be a major reason why many practitioners avoid this procedure. A survey of American endodontists (Stamos & Gutmann 1993) indicated that many of the respondents thought post removal devices were too dangerous, could not be used universally, or they did not work. The presence of a post in a root was also a common reason for respondents to recommend periapical surgery to treat failed cases rather than attempting to remove the post and complete root canal re-treatment, even though the success rate of re-treatment is considered to be higher than for surgery (Allen et al . 1989, Molven et al . 1991). Some of the more common reasons stated by American endodontists (Stamos & Gutmann 1993) for recommending surgery instead of removing a post included an ‘intact post and crown’ (63%), to ‘avoid root fracture/ perforation’ (57%), a ‘large/long/threaded post’ (28%), and ‘cannot remove post after reasonable effort’ (88%). In contrast, a recent survey of endodontists in Australia and New Zealand reported rather different attitudes toward post removal and this was positively correlated to the institution at which they had done their specialty training in endodontics (Castrisos & Abbott 2002). The respondents to this survey indicated that post removal was a common procedure and they were not overly concerned about root fracture.
The concern of dental practitioners toward post removal appears to be related to empirical attitudes developed at dental school rather than being related to any scientific evidence. Only two studies have investigated the safety of post removal devices (Altshul et al . 1997, Castrisos et al . 2001), but the empirical attitudes have been discussed for many years. Altshul et al . (1997) showed more cracks in dentine following the use of ultrasonic vibration to loosen posts, whilst Castrisos et al . (2002) showed that the Eggler post remover was a safe device provided it was used correctly and the post was withdrawn parallel to the long axis of the tooth root.
Orthograde root canal re-treatment is a common procedure. In a study of 2000 patients treated in an endodontic practice, Abbott (1994) reported that 36.7% of the cases required re-treatment and 25.7% of these initially needed post removal. This represented 9.4% of all cases treated and demonstrates that endodontists have to be proficient at removing posts. In order to be proficient, practitioners must have several different devices and techniques available to suit the various types of posts that may require removal. Practitioners must also be confident about selecting cases that can be treated successfully by removal of the posts.
The aim of this study was to determine how successful various post removal techniques were and to determine the incidence of root fractures during post removal in a cohort of patients attending a specialist endodontic practice.

Materials and methods.
This study was conducted in two parts. Part one was a review of patient records for teeth that had posts removed and these were identified by a computer search of treatment codes used for billing purposes. In order to be included, each tooth must have had no clinical or radiographic signs or symptoms and in particular no deep, narrow periodontal pockets to suggest the presence of a root fracture prior to post removal. As part of the author’s routine procedures following post removal, all teeth were re-examined for the presence of root fractures by transilluminating the tooth root with a fibre-optic light from as many different angles as possible. This was done immediately after post removal and at all subsequent appointments during the endodontic re-treatment and follow-up examinations. Periodontal probing was also routinely carried out at subsequent appointments to assess whether any root fractures had occurred. These cases were analysed to determine how many of the posts could be removed and how many roots fractured during post removal. In all, 1600 teeth were identified for inclusion in part one.
In the second part of the study, a more detailed analysis of a sample of 234 of these 1600 teeth was carried out at the time of post removal. These cases were consecutive cases analysed in a prospective manner during a twoyear period to determine the tooth type, the type of post being removed, the device and method used to remove the post, and the time taken to remove the post and core. They were also analysed in the same manner as the other teeth in the first part of the study to determine whether any roots had fractured during post removal.