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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 2  »  A survey of methods used for post removal in specialist endodontic practice
A survey of methods used for post removal in specialist endodontic practice
Results.



There were 62 survey forms returned, which was a response rate of 84% of the ANZAE members. Retreatment of previously root-filled teeth constituted an average of 38% of all treatment performed by the respondents in their practices. The average number of root canal retreatments commenced each month was 27, with an average of three cases per month being treated surgically; the average number of posts removed each month was six. The majority of retreatment cases were treated by orthograde techniques and when a post was present in a tooth that required retreatment, 66% of respondents preferred to remove the posts, whilst 27% considered removing the post or considered doing periapical surgery. Of the respondents who considered post removal and periapical surgery, 75% were concerned that post removal may cause the roots to fracture. However, of those that preferred to remove the post, only 46% were concerned about root fracture.
Forty-seven per cent of the respondents indicated that they would avoid removing posts in certain situations and the most common reason was the presence of a wide post and the concern that the root may fracture. Some other common situations were when:

  1. The coronal restoration was deemed clinically satisfactory, particularly in situations where the cost to replace the coronal restoration was high;
  2. Removal of the restoration would result in the tooth being unrestorable;
  3. The patient chose to have periapical surgery. There was no statistically significant difference in the use of post removal devices amongst respondents who reported avoiding post removal in certain situations ( 2 = 0.81, P = 0.37).

Attitudes about root fracture.
When considering possible complications of post removal, 55% of respondents were concerned about root fracture. The most common reason provided was previous experience of root fracture during post removal procedures and in several instances multiple reasons were given. Of the respondents concerned about root fracture, 61% had experienced the problem, 21% had read about it in journals, 18% were advised at dental school that it may occur, 18% were advised this at continuing education lectures, and 30% stated that this was a personal opinion. All respondents who avoided post removal in certain situations and were concerned about root fracture stated that they avoided removal of wide and long posts in thin roots. There was no association between the use of post removal devices and the respondents who were concerned about root fracture ( 2 = 0.26, P = 0.61).
Forty-five per cent of respondents reported that a root had fractured when removing a post in their clinical experience. Details of the circumstances of the root fracture were supplied by 21 of the 28 respondents who had fractured a root during post removal. The number of root fractures reported was extremely small when compared to the estimated total number of posts removed by endodontists, and represented less than 0.002% of the estimated number of posts removed by all respondents (that is, 40 fractures amongst an estimated 27 800 posts removed). Those respondents who commonly used a post removal device reported past experience of a root fracture more often than those who commonly used only ultrasonic vibration ( 2 = 4.13, P = 0.04). Of the respondents who reported root fractures when removing posts, most were aware of only one or two root fractures during their career. The most commonly reported factors associated with root fracture were a wide post, thin root structure and removing posts at an angle that was different to their path of insertion. There was no association between the use of post removal devices and root fracture, although five respondents reported root fractures whilst using the Auto Abdicator (Reicodent, Germany). This is a springloaded device that is designed to remove crowns rather than posts, although in some cases the posts are removed with the crowns. The most common fractures were small fractures of the coronal dentine but some were small slivers of root dentine, oblique fractures, or incomplete dentine cracks. Complete vertical root fractures were not commonly reported. Two respondents suspected that the root fracture might have been present prior to post removal in cases where fractures were subsequently confirmed. The amount of data provided about root fractures varied and it was not possible to perform meaningful statistical analysis of this data, although it was noted that the respondents who had experienced root fractures when removing posts were more likely to avoid removing posts in certain situations.

Instruments used for post removal.
Respondents were asked to indicate the instruments they had available for post removal and those that they commonly used. The responses to these questions are summarized in Figure 5. Ultrasonic vibration was the most common method reported and it was available in 100% of surgeries and commonly used by 95% of the respondents. This was followed by the Eggler post remover (available in 66% of surgeries and commonly used by 42% of respondents) and the use of the Eggler device was related to the university where postgraduate endodontic training had been completed (Fisher’s exact test P = 0.007). There was no association between use of the Eggler and concerns about root fracture ( 2 = 0.61, P = 0.44) or past experiences of root fracture when removing posts ( 2 = 1.87, P = 0.17). The Masserann kit was available in 43% of surgeries and was commonly used by 16% of the respondents. Use of the Masserann kit was not related to concerns about the risk of root fracture and past experiences with root fracture, although it was related to the university where postgraduate training was completed (Fisher’s exact test P = 0.03). The Gonon (Thomas) and Ruddle post removal systems have a similar method of action and were not commonly used by respondents, hence they were grouped together for the purposes of statistical analysis. These devices were available in 52% of surgeries, but they were commonly used by only 9% of respondents. Since the Gonon and Ruddle post removers were not often used, analysis of their use in relation to concerns about root fracture, the risk of root fracture and postgraduate training was not possible. Several respondents reported that they sometimes used more than one instrument in combination with another and the most common method used in conjunction with another device was ultrasonic vibration.

Instruments available and those commonly used by respondents for the removal of posts
Figures 5. Instruments available and those commonly used by respondents for the removal of posts.

The instruments that would be used by respondents to remove the cast post
Figures 6. The instruments that would be used by respondents to remove the cast post and core from the maxillary incisor tooth shown in Fig. 1.

The graphs presented in Figures 6–9 indicate the primary instrument used to remove the posts in the specific examples shown in the radiographs supplied with the survey questionnaire (Figs 1–4). Ultrasonic vibration was the most common method used to remove the cast post and core from a maxillary incisor tooth (Figs 1, 6). It was the first choice for 58% of respondents and it was used in conjunction with other instruments by 18%. The other instruments used included haemostats, forceps and burs. Ultrasonic vibration was the second choice for 16% of the respondents with their first choice being the use of a post removal device (the Eggler post remover, the Gonon post remover or the Auto Abdicator). Post removal devices were the first choice for 29% of respondents and the second choice for 45%. The Eggler post remover was the most common post remover used, being the first choice for 21% and second choice for 26% of the respondents. The Gonon (Thomas) and Ruddle post removers were the first choice of only 3% of respondents, although 11% indicated that one of these would be their second choice. Forceps and burs were used as the first choice by 5% and 3% of the respondents, respectively. Twenty-seven per cent of respondents did not indicate a second choice for removal of cast posts, but there was no association between those who did not indicate a second choice and their ‘first choice’ instrument. In these cases, it could only be assumed that the respondents were very confident that their ‘first choice’ method would enable them to successfully remove the post.

The instruments that would be used by respondents to remove the parallel preformed post from the maxillary incisor tooth
Figures 7. The instruments that would be used by respondents to remove the parallel preformed post from the maxillary incisor tooth shown in Fig. 2.

The instruments that would be used by respondents to remove the parallel preformed post
Figures 8. The instruments that would be used by respondents to remove the parallel preformed post from the mandibular molar tooth shown in Fig. 3.

Removal of a parallel-sided post in an anterior tooth (Fig. 2) with ultrasonic vibration was the first choice for 61% of the respondents (Fig. 7). Surgery was the first choice treatment for 10%, whilst post removal devices were the first choice for 21% and the second choice of 45% of respondents. The Eggler post remover was used on its own or in conjunction with ultrasonic vibration as the first choice by only 8% of the respondents and as the second choice by 15%. The Gonon (Thomas) and Ruddle post removers were not used by any respondents as the first choice to remove parallel preformed posts in anterior teeth and they were used by only 6% as the second choice. Forceps and burs were used in conjunction with ultrasonic vibration as the first choice by 7% and 3%, respectively, of the respondents. Only 50% indicated a second choice with the instruments used being evenly distributed.
In posterior teeth with a parallel, serrated preformed post (Fig. 3), the use of ultrasonic vibration was the first choice for 87% of respondents (Fig. 8). Only 29% indicated a second choice, with the Masserann kit being the most popular choice. Several respondents stated that the post would be removed by ultrasonics without the need for other devices.

The instruments that would be used by respondents to remove the fractured post from the maxillary incisor tooth root
Figures 9. The instruments that would be used by respondents to remove the fractured post from the maxillary incisor tooth root shown in Fig. 4.

The removal of a fractured post from a maxillary anterior tooth (Fig. 4) would be performed with ultrasonic vibration alone by 54% of the respondents (Fig. 9), although several stated that this would be done with the aid of an operating microscope. The Masserann kit was the first choice of 27% of respondents and those who used a microscope did not tend to use the Masserann kit. Only 34% of respondents indicated a second choice, with half choosing to use the Masserann kit when ultrasonic vibration was not successful in removing the post.