Treatment Concepts for Restoration Of

JCD

Treatment Concepts for Restoration10.5005/jp-journals-10031-1157 of endodontically Treated Teeth RESEARCH ARTICLE

Treatment Concepts for Restoration of endodontically Treated Teeth: A Survey among General Practitioners, Prosthodontists, and Endodontists in India 1Aditya A Kavlekar, 2Meena A Aras, 3Vidya Chitre

ABSTRACT Source of support: Nil Aim: To study the treatment concepts for restoration of end Conflict of interest: None odontically treated teeth (ETT) among general practitioners, prosthodontists, and endodontists in India and to compare practices followed by practitioners in India with that of other INTRODUCTION countries. The aim of Endodontic and Restorative Dentistry is to Materials and methods: A questionnaire consisting of 16 multi preserve the natural tooth structure and to maintain the ple choice questions was formulated. It was handed out randomly stability of dental arch.1 Endodontic treatment is per- to general practitioners, prosthodontists, and endodontists at formed on teeth widely affected due to caries, fractures, respective national conferences by personal handouts. The ques or multiple restorations. Endodontically treated teeth tionnaire consisted of 16 multiple choice questions that focused on the treatment philosophies of post-endodontic restoration, (ETT) are weaker and more liable for fracture as there materials, and techniques used. is loss of tooth structure and change in the physical characteristics.2 Results: 70.7% general practitioners believe that a post rein forces ETT and reduces fracture probability and they placed Studies conducted have proven that the successful posts more frequently as compared to prosthodontists and outcome of an ETT does not depend as much on the endodontists. 44.6% endodontists believed that ferrule does endodontic procedure as much as it depends on the post- not increase the fracture resistance. Cast post and cores were endodontic restoration.1 Post-endodontic restoration of a preferred by 83.2% endodontists, whereas prefabricated posts were preferred by 78.4% general practitioners. Prosthodon tooth with deficient tooth structure is often carried out tists used cast posts and cores as well as prefabricated posts by fabricating a post and core followed by a complete with relatively same frequency. 70.3% endodontists, 74.1% veneer crown. A core is a dental restoration for building general practitioners, and 46.3% prosthodontists preferred up missing tooth structure for future restoration with a tapered posts. 76.2% endodontists seal root filling after post space preparation, whereas 77.7% prosthodontists and 79.3% crown. A post is a dental material placed in the root of a general practitioners do not seal the root filling. 81% prosth structurally deficient tooth when additional retention is odontists and 74.1% general practitioners reported endodontic needed to retain the core and coronal restoration.1 Post- failure as the most frequent cause of failure, however, 79.2% endodontic restorations are dependent on several factors endodontists reported loss of retention of posts. like substance loss, tooth type, whether or not intracanal Conclusion: Within the limitations of the present study, there anchorage is required, choice of post and core material, were differences in knowledge and practices followed in resto length and fit of endodontic post, luting medium, and ration of ETT among the different specialties – prosthodontists, 3,4 endodontists, and general practitioners studied in India and type of supraconstruction. also when compared to other countries. Immense literature has been published with regard to knowledge and practices of post-endodontic restora- Keyword: Endodontically treated teeth, Post and core, Survey. tion abroad; however, there is lack of such studies in How to cite this article: Kavlekar AA, Aras MA, Chitre V. India.5-7 Clinicians are left with the perplexing task of Treatment Concepts for Restoration of endodontically Treated reading and compiling this information into logical Teeth: A Survey among General Practitioners, Prosthodontists, and Endodontists in India. J Contemp Dent 2016;6(2):129-136. and evidence-based approach to dental treatment. The available information is not clear enough to be put up as proper treatment protocol, in lieu of which clinicians rely 1Postgraduate, 2Professor and Head, 3Professor more on their past experiences rather than on available 1-3Department of Prosthodontics, Goa Dental College and literature. The increase in choice of materials and treat- Hospital, Bambolim, Goa, India ment options available for post-endodontic treatment has Corresponding Author: Aditya A Kavlekar, Postgraduate further added to their dilemma. Department of Prosthodontics, Goa Dental College and Hospital As a result, the present survey was undertaken to Bambolim, Goa, India, Phone: +918554071084, e-mail: aditya. investigate the frequency of preferred methods, mate- [email protected] rials, timing, and other concerning factors regarding Journal of Contemporary Dentistry, May-August 2016;6(2):129-136 129 Aditya A Kavlekar et al restorations of ETT with special emphasis on assessing Cause of Failure the knowledge and practices used by prosthodontists, The participants were questioned regarding the cause of endodontists, and general practitioners in India. The most frequent cause of failure of post placement. present survey also allowed comparisons of beliefs and practices in restoration of ETT followed by practitioners RESULTS in India with that of other countries. Demographics MATERIALS AND METHODS The questionnaire was answered by 116 general practi- A questionnaire consisting of 16 multiple choice questions tioners, 121 prosthodontists, and 101 endodontists with was formulated. A cover letter stated the instructions, an overall return rate of 37%. Majority of prosthodontists rationale, and purpose of the survey. It was handed and endodontists were males 58.7% to 71.3% respectively; out randomly to general practitioners, prosthodontists, however, majority of the general practitioners were female and endodontists at respective national conferences by 66.4%. 50.4% of prosthodontists and 52.5% endodontists personal handouts. The questionnaire asked for anony- had a clinical experience of 0 to 5 years, whereas 41.4% mous responses so as to overcome any reservation about of general practitioners had a clinical experience of 5 to participation. 10 years. A total of 69.4% of prosthodontists and 56.4% of The first part of the questionnaire consisted of general endodontists had not attended any special course, whereas personal information of the dentist like gender, qualifica- 54.3% general practitioners had undergone special courses tion, number of years of practice, and whether he/she had to upgrade their skills with regard to restoration of ETT. attended any special course for post and core. Beliefs and Frequency of Use The second part of the questionnaire consisted of 16 of Intracanal Posts multiple choice questions that focused on the treatment philosophies of post-endodontic restoration, materials, 89.3% prosthodontists, 81.2% endodontists, and 90.5% and techniques used. The questions covered the follow- general practitioners believed that every ETT need ing topics: not receive a post (Table 1). 83.5% prosthodontists and 83.2% endodontists seldom place posts whereas 53.4% Beliefs and Frequency of Use of general practitioners frequently placed posts in ETT. of Intracanal Posts 70.7% general practitioners believe that a post definitely reinforces an ETT and reduces fracture probability The participants were asked how frequently they placed whereas 68.6% prosthodontists and 80.2% endodontists posts and their beliefs whether every ETT must receive a believe that posts with adhesive luting reinforces an post, whether post reinforces ETT and reduces fracture ETT and reduces fracture probability (Graph 1). 82.6% probability, and whether a ferrule effect increases fracture prosthodontists and 75% general practitioners believe resistance. that using ferrule increases fracture resistance whereas only 55.4% endodontists believe in fracture resistance Prosthetic Restoration effect of ferrule (Graph 2). The participants were questioned about frequency of use of posts depending on tooth location and restoration Prosthetic Restoration modalities. With regard to tooth location, a more equitable frequency of post placement is seen for all tooth locations by prosth- Materials Preferences odontists, i.e., molars (26.4%), premolars (33.9%), and anterior teeth (39.7%) whereas endodontists and general The participants were questioned with regard to com- practitioners place posts more frequently in only premo- monly used post system, post design, material used to lars and anterior teeth (Table 2). 47.5% endodontists place construct core, and cement used to lute post. posts more frequently in premolars whereas 48.5% place more frequently in anterior teeth. 58.6% general prac- Techniques of Post Space Preparation titioners place posts more frequently in premolars and Questions related to timing of post space preparation fol- whereas 38.8% place more frequently in anterior teeth. lowing endodontic therapy, instruments used to remove 87.1% endodontists and 85.3% general practitioners use root filling material, solution used to rinse canal before posts more frequently for single-crown therapy, whereas cementation, and whether root filling was sealed after only 68.6% prosthodontists use posts more frequently post space preparation were asked. for single-crown therapy and 21.5% prosthodontists use 130 JCD

Treatment Concepts for Restoration of endodontically Treated Teeth

Table 1: Responses regarding beliefs and frequency of use of intracanal posts General Prosthodontist Endodontist practitioner Question Response (%) (%) (%) (1) Do you believe that every endodontically (a) Yes 10.7 18.8 9.5 treated tooth must receive a post? (b) No 89.3 81.2 90.5 (2) How frequently do you place post in your (a) Seldom (30% of all ETT) 83.5 83.2 45.7 dental practice? (b) Frequently (30–70% of all ETT) 13.2 14.9 53.4 (c) Usually (>70% of all ETT) 3.3 2 0.9 (3) Do you believe that a post reinforces an (a) Yes, definitely 4.1 14.9 70.7 endodontically treated tooth and reduces (b) Yes, with adhesive luting 68.6 80.2 16.4 fracture probability? (c) Yes, with conventional luting 0.8 0 0 (d) No 26.4 5 12.9 (4) Do you believe that reducing the level of (a) Yes 82.6 55.4 75 finishing line below the core foundation, (b) No 17.4 44.6 25 thus using a ferrule effect following post cementation increases the fracture resistance?

Graph 1: Comparison of responses of different dental specialties Graph 2: Comparison of responses of different dental specialties based on belief that a post reinforces an ETT and reduces fracture based on belief that a ferrule increases fracture resistance probability

Table 2: Responses regarding prosthetic restoration Prosthodontist Endodontist General Question Response (%) (%) practitioner (%) (1) In which teeth do you frequently use posts (a) Molars 26.4 4 2.6 for restoration of endodontically treated (b) Premolars 33.9 47.5 58.6 tooth? (c) Anteriors 39.7 48.5 38.8 (2) For which of the following restoration (a) Direct restorations 9.9 1 6.9 modalities do you use posts more often for (b) Single-crown therapy 68.6 87.1 85.3 restoring ETT? (c) Abutment teeth for FPD 21.5 11.9 7.8 posts more frequently to restore abutment teeth for fixed posts more frequently whereas 52.9% prosthodontists partial dentures (FPDs). place prefabricated posts while 47.1% place cast posts (Graph 3, Table 3). With regard to post designs, 70.3% Materials Preferences endodontists and 74.1% general practitioners preferred 83.2% endodontists use casts posts more frequently, tapered posts whereas when compared to prosthodon- however, 78.4% general practitioners place prefabricated tists, 46.3% preferred tapered posts, 21.5% preferred Journal of Contemporary Dentistry, May-August 2016;6(2):129-136 131 Aditya A Kavlekar et al

Techniques of Post Space Preparation 80.2% prosthodontists, 78.2% endodontists, and 81.9% general practitioners wait for 1 week after root has been filled to prepare the canal for post (Table 4). Among prosthodontists, 60.3% remove root fillings with conventional burs more frequently whereas 39.7% preferred to use special burs supplied by manufacturers whereas among endodontists, 83.2% preferred conventional burs while 16.8% preferred special burs; however, among general practitioners, 56.9% preferred special burs while 43.1% preferred conventional burs. 76.2% endodontists seal root filling after post space preparation whereas 77.7% prosthodontists and 79.3% general practitioners

Graph 3: Comparison of responses of different dental do not seal root filling after post space preparation. 76% specialties based on frequency of post system used prosthodontists rinse canal with distilled water, 66.3% endodontists rinse with sodium hypochlorite whereas 56% general practitioners do not rinse canal before post combined parallel sided/tapered posts, and 20.7% cementation. 69.3% endodontists and 62.9% general prac- preferred parallel posts. Among general practitioners, titioners apply cement to post to place cement in canal 49.1% use composite cores and 17.2% use glass ionomer whereas among prosthodontists, 38.8% apply cement to cement cores on prefabricated posts more commonly. post to place cement in canal while 34.7% apply cement Among endodontists, 51.5% used cores other than that to canal with a lentulo spiral. mentioned in the options whereas 26.7% used amalgam cores, however among prosthodontists, 30.6% used Cause of Failure composite cores more commonly whereas 28.9% used cores other than that mentioned on the options. Among 81% prosthodontists reported endodontic failure while prosthodontists, 41.3% prefer glass ionomer cement, 12.4% reported loss of retention of post as the most fre- 32.2% prefer resin cement whereas 26.4% prefer zinc quent cause of failure (Table 5). Similarly 74.1% general phosphate cement to lute the post; however, among practitioners reported endodontic failure while 12.9% endodontists, 37.6% prefer glass ionomer cement and reported loss of retention of post as most frequent cause 46.5% zinc phosphate cement. Among general practitio- of failure. However, 79.2% endodontists reported loss of ners, 56.9% prefer resin cement and 27.6% prefer glass retention of posts while 16.8% reported endodontic failure ionomer cement. as most frequent cause of failure (Graph 4).

Table 3: Responses regarding materials preferences Prosthodontist Endodontist General Question Response (%) (%) practitioner (%) (1) Which post system do you use more (a) Cast posts 47.1 83.2 21.6 frequently? (b) Prefabricated post 52.9 16.8 78.4 (2) Which of the following post designs (a) Tapered posts 46.3 70.3 74.1 do you prefer? (b) Parallel posts 20.7 27.7 17.2 (c) Combined parallel-sided/tapered 21.5 1 4.3 (d) Screw type 9.1 1 2.6 (e) Split flexible post 2.5 0 1.7 (3) Which material do you use more (a) Composite 30.6 13.9 49.1 commonly to construct core on (b) Glass ionomer cement 18.2 7.9 17.2 prefabricated post? (c) Resin modified glass ionomer cement 6.6 0 12.1 (d) Amalgam 15.7 26.7 6 (e) If other than these (please specify) 28.9 51.5 15.5 (4) Which cement do you use to lute a (a) Zinc phosphate cement 26.4 46.5 15.5 post? (b) Glass ionomer cement 41.3 37.6 27.6 (c) Polycarboxylate cement 0 0 0 (d) Resin cement 32.2 15.8 56.9

132 JCD

Treatment Concepts for Restoration of endodontically Treated Teeth

Table 4: Responses regarding techniques of post space preparation Prosthodontist Endodontist General Question Response (%) (%) practitioner (%) (1) When do you prepare the (a) Immediately after root has been filled 10.7 19.8 1.7 canal for post? (b) Wait for 1 week after root has been filled 80.2 78.2 81.9 (c) If other than these (please specify) 9.1 2 16.4 (2) How do you remove the (a) Conventional rotary instruments, e.g., Gates 60.3 83.2 43.1 root filling material? Glidden drills, pezoreamers (b) Special burs supplied by manufacturers 39.7 16.8 56.9 (c) Round burs 0 0 0 (d) Hand reamers 0 0 0 (e) Heated instruments 0 0 0 (f) Solvents 0 0 0 (3) Do you seal the root filling (a) Yes 22.3 76.2 20.7 after preparing the canal (b) No 77.7 23.8 79.3 for a post? (4) Which solution do you use (a) Distilled water 76 30.7 36.2 to rinse the canal before (b) Hydrogen peroxide 5.8 1 3.4 cementing the posts? (c) Sodium hypochlorite 9.1 66.3 2.6 (d) EDTA 2.5 0 1.7 (e) Chlorhexidine 2.5 0 0 (f) Do not rinse 4.1 2 56 (5) Which method do you use (a) Apply it to the post before placing in canal 38.8 69.3 62.9 to place the cement in (b) Applying cement to canal by probe 19.8 26.7 23.3 canal? (c) Applying cement to canal with a lentulo spiral 34.7 0 6.9 (d) Applying cement to canal with small plastic tube 6.6 4 6.9

Table 5: Responses regarding cause of failure General Question Response Prosthodontist (%) Endodontist (%) practitioner (%) (1) Which is the most frequent failure? (a) Loss of retention of posts 12.4 79.2 12.9 (b) Endodontic failure 81 16.8 74.1 (c) Crown fracture 2.5 0 0 (d) Root fracture 4.1 2 10.3 (e) No failures 0 2 2.6

Majority of the respondents, 89.3% prosthodontists, 81.2% endodontists, and 90.5% general practitioners were not of the opinion that every ETT must receive a post which is commensurate with the consensus in the literature. Most prosthodontists and endodontists place posts in 30% of all ETT whereas most general practitioners place posts in 30 to 70% of all ETT which is less frequent than a comparable study carried out in Germany.7 Studies have demonstrated that a post does not rein- force ETT and reduce fracture probability.8-12 Contrary to this, a large percentage of general practitioners were of the opinion that a post reinforces ETT which is much higher than studies carried out in Sweden, Germany, and United States.7,13,14 This may be the reason for majority of general Graph 4: Comparison of responses of different dental practitioners placing posts frequently in ETT. However, specialties based on most frequent failure in the present study, majority of prosthodontists (68.6%) and endodontists (80.2%) believed in reinforcement effect DISCUSSION when posts were used with adhesive luting whereas in The overall return rate of the questionnaire was 37% Germany, only a minority believe in reinforcement effect which is in line with other studies.5,6 Due to anonymous when post placement is performed either adhesively or nature of the study, it was not possible to send reminders. conventionally.7 Journal of Contemporary Dentistry, May-August 2016;6(2):129-136 133 Aditya A Kavlekar et al

As compared to studies in Sweden, United States, mentioned in the options in the present study. In the and Germany, a higher percentage of prosthodontists United States and UK, amalgam cores are more popular and general practitioners believed that a reinforcement whereas majority of German and Swedish dentists use effect by using a ferrule exists which is in agreement with composite resin cores.5,7,13,14 literature which suggests posts made with ferrule have Glass ionomer cement was the preferred cement to lute increased resistance to failure. However, in the present posts for most prosthodontists and endodontists whereas study, lesser percentage of endodontists believe in frac- majority of general practitioners preferred resin cement. ture resistance effect of ferrule.7,13 -17 In Sweden, zinc phosphate was preferred cement among According to literature, anterior teeth with minimal both prosthodontists and general practitioners whereas access cavity can be restored with composite resin. Pre- in United States and Northern Ireland, glass ionomer was molars and molars with minimal access cavities can be preferred among general practitioners while only few restored with amalgam or composite resin in combination prosthodontists used this cement for luting.13,14,19 with a resin bonding system. Posterior teeth with large Most prosthodontists, endodontists, and general access cavities following extensive carious lesions carry practitioners preferred to wait for 1 week after root had greater occlusal loads and therefore require protection been filled to prepare canal for posts which is comparable against possible fracture by cuspal coverage.11,18 However, to a study in Northern Ireland. This result is, however, majority of endodontists and general practitioners place contrary to Swedish dentists who prefer to prepare the posts more frequently in premolars and anteriors. This canal for posts immediately after root has been filled.13,19 may be due to extensive caries in these teeth or due to Prosthodontists and endodontists preferred to remove discoloration requiring coverage in esthetic areas. In a root fillings with conventional burs which is similar to similar study in Sweden, it was more common to use the practice followed by dentists in Sweden and United posts in endodontically treated molars and premolars.13 States whereas most general practitioners in the present Most prosthodontists, endodontists, and general study prefer special burs supplied by manufacturers.13,14 practitioners use posts more commonly for single-crown It has been recommended to seal the root filling therapy; however, few prosthodontists also use posts for after post space preparation to obtain a dense seal to abutment teeth for FPD. The possible explanation may prevent risk of coronal leakage which is a causal factor be to increase the retention of crown or due to belief of for root canal failure.23-27 Most endodontists seal root reinforcement effect of posts. In the study in Sweden, filling after post space preparation whereas majority of the use of posts for abutments for FPDs was much more prosthodontists and general practitioners do not seal. In common compared to single-crown therapy.13 a comparable study in Sweden, 48% prosthodontists and It was more common among endodontists to use cast 34% general practitioners practiced sealing root filling. posts whereas most general practitioners use prefabri- Most commonly used material for this was zinc oxide- cated posts more frequently, which may be due to the fact eugenol cement.13 that prefabricated posts are easy to use and require less Rinsing of canal is recommended before post cemen- chairside time. However, among prosthodontists, casts tation to remove the smear layer formed after instrumen- posts were used with same frequency as prefabricated tation of root canal.28 Most prosthodontists use distilled posts. In Germany and UK, there was a preference for water, while endodontists preferred sodium hypochlorite, prefabricated posts, however, Swedish and British den- however most general practitioners do not rinse canal tists preferred cast post and core.5,7,13,19 In Sweden and before post cementation. All prosthodontists and 92% United States, use of cast posts was more common among of general practitioners in Sweden followed this recom- prosthodontists compared to general practitioners.13,14 mendation. Hydrogen peroxide + alcohol and Tubulicid Endodontists and general practitioners preferred (Dental therapeutics) were the commonly used rinsing tapered posts though according to literature tapered posts solutions used by them.13 have higher failure rates than both prefabricated and cast Endodontists and general practitioners preferred to parallel-sided posts except for teeth with ovoid canals.20-22 apply cement to post to place cement in canal whereas However, among prosthodontists, most preferred tapered among prosthodontists, 38.8% apply cement to post to posts, while a minority preferred combined parallel- place cement in canal while 34.7% apply cement to canal sided/tapered posts and parallel posts. In Germany, with a lentulo spiral. In Sweden, 32% general practitioners screw-type posts were the preferred post design which applied cement to the post before placing it in the canal was followed by tapered posts.7 whereas 37% prosthodontists used a small plastic tube Most general practitioners and prosthodontists use to perform this procedure.13 composite cores more frequently on prefabricated posts Most prosthodontists and general practitioners whereas most endodontists used cores other than that reported endodontic failure as the most frequent cause 134 JCD

Treatment Concepts for Restoration of endodontically Treated Teeth of failure, however, most endodontists reported loss whereas among prosthodontists, 38.8% apply cement of retention of posts as a cause of failure. In a study in to post to place cement in canal while 34.7% apply Germany, loss of retention (43%) was the most common cement to canal with a lentulo spiral. reason for failure followed by endodontic problems (36%) • 81% prosthodontists and 74.1% general practitioners and root fractures (29%).7 reported endodontic failure as the most frequent cause The present study exhibited variations in the knowl- of failure, however, 79.2% endodontists reported loss edge and practices among clinicians in different countries of retention of posts. and different specialties in India. The inconsistency in • There were difference in knowledge and practices treatment modalities could be due to the fact that long- followed in restoration of ETT among clinicians in term studies on success rate of different restoration different countries as well as between the differ- techniques are scarce. If long-term randomized trials are ent specialties – prosthodontists, endodontists, and conducted in the community then a homogenous clinical general practitioners studied in India. trial-based dental practice will emerge. Due to contradic- tory responses, it is not possible to recommend a standard REFERENCES treatment protocol for restoration of ETT. 1. Chadwick J, Gonzales A, McLean C, Naghavi A, Rosati S, Yau S. Restoration of endodontically treated teeth: An evi- CONCLUSION dence based literature review. University of Toronto, Faculty of Dentistry-Community Dentistry 2008; p. 1-21. Within the limitations of this study, the following conclu- 2. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiff- sions were drawn: ness as a result of endodontic restorative procedures. J Endod • 89.3% prosthodontists, 81.2% endodontists, and 90.5% 1989 Nov;15(11):152-156. general practitioners were not of the opinion that 3. Al-Omiri MK, Mahmoud AA, Rayyyan MR, Abu-Hammad O. Fracture resistance of teeth restored with post-retained every ETT must receive a post. restorations: An overview. J Endod 2010 Sep;36(9):1439-1449. • 70.7% general practitioners were in the false belief 4. Biter K, Kielbassa AM. Post-endodontic restorations with that a post reinforces ETT and reduces fracture prob- adhesively luted fiber-reinforced composite post systems: ability and place posts more frequently as compared A review. Am J Dent 2007 Dec;20(7):353-360. to prosthodontists and endodontists. 5. Seow LL, Toh CG, Wilson NH. A survey of current practices • 44.6% endodontists were in the false belief that ferrule among general dental practitioners in Manchester in 2002. Prim Dent Care 2003 Jul;10(3):87-92. does not increase the fracture resistance. 6. Brunton PA, Christensen GJ, Cheung SW, Burke FJ, • Cast post and cores were preferred by 83.2% endo- Wilson NH. Contemporary dental practice in the UK: Indi- dontists whereas prefabricated posts were preferred rect restorations and fixed prosthodontics. Br Dent J 2005 by 78.4% general practitioners. Prosthodontists used Jan;198(2):99-103. cast posts and cores as well as prefabricated posts 7. Naumann M, Kiessling S, Seemann R. Treatment concepts for restoration of endodontically treated teeth: A nation- with relatively same frequency. wide survey of dentists in Germany. J Prosthet Dent 2006 • 70.3% endodontists, 74.1% general practitioners, and Nov;96(5):332-338. 46.3% prosthodontists preferred tapered posts which 8. Lovdahl PE, Nicholls JI. Pin-retained amalgam cores vs cast- is contrary to the present consensus that tapered posts gold dowel-cores. J Prosthet Dent 1977 Nov;38(5):507-514. have a higher failure rate. 9. Guzy GE, Nicholls JI. In vitro comparison of intact endodonti- • 41.3% prosthodontists and 37.6% endodontists pre- cally treated teeth with and without endo-post reinforcement. J Prosthet Dent 1979 Jul;42(1):39-44. ferred glass ionomer cement to lute posts whereas 10. Sorensen JA, Martinoff JT. Intracoronal reinforcement and 56.9% general practitioners preferred resin cement. coronal coverage: A study of endodontically treated teeth. • 60.3% prosthodontists and 83.2% endodontists J Prosthet Dent 1984 Jun;51(6):780-784. preferred conventional burs to remove root fillings 11. Trope M, Maltz DO, Tronstad L. Resistance to fracture of whereas general practitioners preferred special burs restored endodontically treated teeth. Endod Dent Traumatol supplied by manufacturers. 1985 Jun;1(3):108-111. 12. Assif D, Bitenski A, Pilo R, Oren E. Effect of post design on • 76.2% endodontists seal root filling after post space resistance to fracture of endodontically treated teeth with preparation whereas 77.7% prosthodontists and 79.3% complete crowns. J Prosthet Dent 1993 Jan;69(1):36-40. general practitioners do not seal the root filling. 13. Eckerbom M, Magnusson T. Restoring endodontically treated • 76% prosthodontists use distilled water, while 66.3% teeth: A survey of current opinions among board-certified endodontists use sodium hypochlorite to rinse the prosthodontists and general dental practitioners in Sweden. Int J Prosthodont 2001 May-Jun;14(3):245-249. canal and 56% general practitioners do not rinse canal 14. Morgano SM, Hashem AF, Fotoohi K, Rose L. A nation wide before post cementation. survey of contemporary philosophies and techniques of • 69.3% endodontists and 62.9% general practitioners restoring endodontically treated teeth. J Prosthet Dent 1994 apply cement to post to place cement in the canal Sep;72(3):259-267. Journal of Contemporary Dentistry, May-August 2016;6(2):129-136 135 Aditya A Kavlekar et al

15. Gelfand M, Goldman M, Sunderland EJ. Effect of complete 22. Morgano SM, Brackett SE. Foundation restorations in fixed veneer crowns on the compressive strength of endodontically prosthodontics: Current knowledge and future needs. treated posterior teeth. J Prosthet Dent 1984 Nov;52(5):635-638. J Prosthet Dent 1999 Dec;82(6):643-657. 16. Barkhordar RA, Radke R, Abbasi J. Effect of metal collars on 23. Saunders WP, Saunders EM. Coronal leakage as a cause of resistance of endodontically treated teeth to root fracture. failure in root-canal therapy: A review. Endod Dent Trauma- J Prosthet Dent 1989 Jun;61(6):676-678. tol 1994 Jun;10(3):105-108. 17. Isidor F, Bröndum K, Ravnholt G. The influence of post 24. Beckham BM, Anderson RW, Morris CF. An evaluation of length and crown ferrule length on the resistance to cyclic three materials as barriers to coronal microleakage in end- loading of bovine teeth with prefabricated titanium posts. odontically treated teeth. J Endod 1993 Aug;19(8):388-391. Int J Prosthodont 1999 Jan-Feb;12(1):78-82. 25. Ray HA, Trope M. Periapical status of endodontically treated 18. Morgano SM. Restoration of pulpless teeth: Application of teeth in relation to the technical quality of the root filling and traditional principles in present and future contexts. J Pros- the coronal restoration. Int Endod J 1995 Jan;28(1):12-18. thet Dent 1996 Apr;75(4):375-380. 26. Swanson K, Madison LR. An evaluation of coronal micro- 19. Hussey DL, Killough SA. A survey of general dental prac- leakage in endodontically treated teeth. Part I. Time periods. titioners approach to the restoration of root-filled teeth. Int J Endod 1987 Feb;13(2):56-59. Endod J 1995 Mar;28(2):91-94. 27. Wu MK, Pehlivan Y, Kontakiotis EG, Wesselink PR. Microle- 20. Sorensen JA, Martinoff JT. Clinically significant factors in akage along apical root fillings and cemented posts. J Prosthet dowel design. J Prosthet Dent 1984 Jul;52(1):28-35. Dent 1998 Mar;79(3):264-269. 21. Torbjörner A, Karlsson S, Ödman PA. Survival rate and 28. McComb D, Smith DC. A preliminary scanning electron failure characteristics for two post designs. J Prosthet Dent microscopic study of root canals after endodontic procedures. 1995 May;73(5):439-444. J Endod 1975 Jul;1(7):238-242.

136