Post Removal Using Guided Endodontics: A Systematic Review of the Literature
Article Main Content
Introduction: The aim of this review was to gather and assess all available evidence regarding the efficacy and complications of guided endodontics in the removal of dental posts.
Methods: A systematic review was carried out by three reviewers in PubMed/MEDLINE, Scopus, and Web of Science databases. All clinical trials, observational studies, in vitro and ex vivo studies, case reports, and case series that reported the use of CBCT to create guides for dental post removal up to July 2023 were eligible for inclusion. The quality of the included studies was assessed by the reviewers using the CARE guidelines and the QUIN tool. A predetermined template was used to extract data regarding the participant characteristics, printer, materials, software, and clinical parameters of the procedure.
Results: A total of nine studies were included. Of those, seven were case reports and two were in vitro studies. All the included publications showed that the use of guided endodontics was effective in the removal of the post. Complications were observed in only two cases. Studies showed variability among the techniques used, but all were successful. Accuracy was reported in only two studies.
Conclusion: Within the limitations of this review, guided endodontics showed to be an effective technique for the removal of dental posts with a low risk of iatrogenic errors. The quality and amount of available evidence is still low. Future well-designed studies are essential to establish these findings.
References
-
Sarkis-Onofre R, Amaral Pinheiro H, Poletto-Neto V, Bergoli CD, Cenci MS, Pereira-Cenci T. Randomized controlled trial comparing glass fiber posts and cast metal posts. J Dent. 2020;96:103334. doi: 10.1016/j.jdent.2020.103334.
Google Scholar
1
-
Marchionatti AME, Wandscher VF, Rippe MP, Kaizer OB, Valandro LF. Clinical performance and failure modes of pulpless teeth restored with posts: a systematic review. Braz Oral Res. 2017;31:e64. doi: 10.1590/1807-3107BOR-2017.
Google Scholar
2
-
Skupien JA, Luz MS, Pereira-Cenci T. Ferrule Effect: A Meta-analysis. JDR Clin Trans Res. 2016;1(1):31-39. doi: 10.1177/2380084416636606. PMID: 30931698.
Google Scholar
3
-
Sorrentino R, Di Mauro MI, Ferrari M, Leone R, Zarone F. Complications of endodontically treated teeth restored with fiber posts and single crowns or fixed dental prostheses-a systematic review. Clin Oral Investig. 2016 Sep;20(7):1449-57. doi: 10.1007/s00784-016-1919-8.
Google Scholar
4
-
Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature - part 1. Effects of study characteristics on probability of success. Int Endod J. 2007 Dec;40(12):921-39. doi: 10.1111/j.1365-2591.2007.01322.x.
Google Scholar
5
-
Sathorn C, Palamara JE, Messer HH. A comparison of the effects of two canal preparation techniques on root fracture susceptibility and fracture pattern. J Endod. 2005;31(4):283-7. doi: 10.1097/01.don.0000140580.03121.61.
Google Scholar
6
-
Fu M, Huang X, Zhang K, Hou B. Effects of Ultrasonic Removal of Fractured Files from the Middle Third of Root Canals on the Resistance to Vertical Root Fracture. J Endod. 2019;45(11):1365-1370. doi: 10.1016/j.joen.2019.08.009.
Google Scholar
7
-
Ossareh A, Rosentritt M, Kishen A. Biomechanical studies on the effect of iatrogenic dentin removal on vertical root fractures. J Conserv Dent. 2018;21(3):290-296. doi: 10.4103/JCD.JCD_126_18.
Google Scholar
8
-
Haupt F, Riggers I, Konietschke F, Rödig T. Effectiveness of different fiber post removal techniques and their influence on dentinal microcrack formation. Clin Oral Investig. 2022;26(4):3679-3685. doi: 10.1007/s00784-021-04338-0.
Google Scholar
9
-
Lindemann M, Yaman P, Dennison JB, Herrero AA. Comparison of the efficiency and effectiveness of various techniques for removal of fiber posts. J Endod. 2005;31(7):520-2. doi: 10.1097/01.don.0000167397.60943.6e.
Google Scholar
10
-
Abbott PV. Incidence of root fractures and methods used for post removal. Int Endod J. 2002;35(1):63-7. doi: 10.1046/j.1365-2591.2002.00457.x.
Google Scholar
11
-
Anderson GC, Perdigão J, Hodges JS, Bowles WR. Efficiency and effectiveness of fiber post removal using 3 techniques. Quintessence Int. 2007;38(8):663-70.
Google Scholar
12
-
AlShabib A, Brindley S, Satterthwaite J. Evaluation of the efficacy of two fibre-reinforced post removal techniques. Eur J Prosthodont Restor Dent. 2022;30(3):239-244. doi: 10.1922/EJPRD_02101AlShabib06.
Google Scholar
13
-
Moreno-Rabié C, Torres A, Lambrechts P, Jacobs R. Clinical applications, accuracy and limitations of guided endodontics: a systematic review. Int Endod J. 2020;53(2):214-231. doi: 10.1111/iej.13216.
Google Scholar
14
-
Peña-Bengoa F, Valenzuela M, Flores MJ, Dufey N, Pinto KP, Silva EJNL. Effectiveness of guided endodontics in locating calcified root canals: a systematic review. Clin Oral Investig. 2023;27(5):2359-2374. doi: 10.1007/s00784-023-04863-0.
Google Scholar
15
-
Loureiro MAZ, Elias MRA, Capeletti LR, Silva JA, Siqueira PC, Chaves GS, et al. Guided endodontics: Volume of dental tissue removed by guided access cavity preparation-an ex vivo study. J Endod. 2020;46(12):1907-1912. doi: 10.1016/j.joen.2020.09.008.
Google Scholar
16
-
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.
Google Scholar
17
-
Akobeng AK. Principles of evidence based medicine. Arch Dis Child. 2005;90(8):837-40. doi: 10.1136/adc.2005.071761.
Google Scholar
18
-
Sheth VH, Shah NP, Jain R, Bhanushali N, Bhatnagar V. Development and validation of a risk-of-bias tool for assessing in vitro studies conducted in dentistry: The QUIN. J Prosthet Dent. 2022:S0022-3913(22)00345-6. doi: 10.1016/j.prosdent.2022.05.019.
Google Scholar
19
-
Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017 Sep;89:218-235. doi: 10.1016/j.jclinepi.2017.04.026.
Google Scholar
20
-
Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews. 2022;18, e1230. https://doi.org/10.1002/cl2.1230.
Google Scholar
21
-
Alfadda A, Alfadley A, Jamleh A. Fiber Post Removal using a conservative fully guided approach: a dental technique. Case Rep Dent. 2022;2022:3752466. doi: 10.1155/2022/3752466.
Google Scholar
22
-
Cho C, Jo HJ, Ha JH. Fiber-reinforced composite post removal using guided endodontics: a case report. Restor Dent Endod. 2021;46(4):e50. doi: 10.5395/rde.2021.46.e50.
Google Scholar
23
-
Liu R, Xie C, Sun M, Yu H. Guided removal of a fractured fiber post and immediate restoration with a digitally prefabricated titanium post-and-core and zirconia crown: A clinical report. J Prosthet Dent. 2023;129(5):684-689. doi: 10.1016/j.prosdent.2021.07.017.
Google Scholar
24
-
Maia LM, Bambirra Júnior W, Toubes KM, Moreira Júnior G, de Carvalho Machado V, Parpinelli BC, et al. Endodontic guide for the conservative removal of a fiber-reinforced composite resin post. J Prosthet Dent. 2022;128(1):4-7. doi: 10.1016/j.prosdent.2020.11.044.
Google Scholar
25
-
Perez C, Finelle G, Couvrechel C. Optimisation of a guided endodontics protocol for removal of fibre-reinforced posts. Aust Endod J. 2020;46(1):107-114. doi: 10.1111/aej.12379.
Google Scholar
26
-
Schwindling FS, Tasaka A, Hilgenfeld T, Rammelsberg P, Zenthöfer A. Three-dimensional-guided removal and preparation of dental root posts-concept and feasibility. J Prosthodont Res. 2020;64(1):104-108. doi: 10.1016/j.jpor.2019.04.005.
Google Scholar
27
-
Xue Y, Zhang L, Cao Y, Zhou Y, Xie Q, Xu X. A three-dimensional printed assembled sleeveless guide system for fiber-post removal. J Prosthodont. 2023;32(2):178-184. doi: 10.1111/jopr.13634.
Google Scholar
28
-
Fachin GF, Dinato TR, Prates FB, Connert T, Pelegrine RA, Bueno CEdS. Guided access through ceramic crowns with fiberglass post removal in lower molars: an in vitro study. Applied Sciences. 2023; 13(9):5516. https://doi.org/10.3390/app13095516.
Google Scholar
29
-
Perez C, Sayeh A, Etienne O, Gros CI, Mark A, Couvrechel C, Meyer F. Microguided endodontics: Accuracy evaluation for access through intraroot fibre-post. Aust Endod J. 2021;47(3):592-598. doi: 10.1111/aej.12524.
Google Scholar
30
-
Janabi A, Tordik PA, Griffin IL, Mostoufi B, Price JB, Chand P, et al. Accuracy and efficiency of 3-dimensional dynamic navigation system for removal of fiber post from root canal-treated teeth. J Endod. 2021;47(9):1453-1460. doi: 10.1016/j.joen.2021.07.002.
Google Scholar
31
-
de Rijk WG. Removal of fiber posts from endodontically treated teeth. Am J Dent. 2000;13(Spec No):19B-21B.
Google Scholar
32
-
Buchgreitz J, Buchgreitz M, Mortensen D, Bjørndal L. Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study. Int Endod J. 2016;49(8):790-5. doi: 10.1111/iej.12516.
Google Scholar
33
-
Buchgreitz J, Buchgreitz M, Bjørndal L. Guided root canal preparation using cone beam computed tomography and optical surface scans - an observational study of pulp space obliteration and drill path depth in 50 patients. Int Endod J. 2019.
Google Scholar
34
-
Zehnder MS, Connert T, Weiger R, Krastl G, Kühl S. Guided endodontics: accuracy of a novel method for guided access cavity preparation and root canal location. Int Endod J. 2016;49(10):966-72. doi: 10.1111/iej.12544.
Google Scholar
35
-
Connert T, Zehnder MS, Amato M, Weiger R, Kühl S, Krastl G. Microguided Endodontics: a method to achieve minimally invasive access cavity preparation and root canal location in mandibular incisors using a novel computer-guided technique. Int Endod J. 2018;51(2):247-255. doi: 10.1111/iej.12809.
Google Scholar
36
-
Fonseca Tavares WL, Diniz Viana AC, de Carvalho Machado V, Feitosa Henriques LC, Ribeiro Sobrinho AP. Guided endodontic access of calcified anterior teeth. J Endod. 2018;44(7):1195-1199. doi: 10.1016/j.joen.2018.04.014.
Google Scholar
37
-
Kostunov J, Rammelsberg P, Klotz AL, Zenthöfer A, Schwindling FS. Minimization of tooth substance removal in normally calcified teeth using guided endodontics: an in vitro pilot study. J Endod. 2021;47(2):286-290. doi: 10.1016/j.joen.2020.10.025.
Google Scholar
38
-
Connert T, Krug R, Eggmann F, Emsermann I, ElAyouti A, Weiger R, et al. Guided Endodontics versus Conventional Access Cavity Preparation: A Comparative Study on Substance Loss Using 3-dimensional-printed Teeth. J Endod. 2019;45(3):327-331. doi: 10.1016/j.joen.2018.11.006.
Google Scholar
39
-
Rodrigues CT, Jacobs R, Vasconcelos KF, Lambrechts P, Rubira-Bullen IRF, Gaêta-Araujo H, et al. Influence of CBCT-based volumetric distortion and beam hardening artefacts on the assessment of root canal filling quality in isthmus-containing molars. Dentomaxillofac Radiol. 20211;50(5):20200503. doi: 10.1259/dmfr.20200503.
Google Scholar
40
-
Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J. 2015 Jan;48(1):3-15. doi: 10.1111/iej.12270.
Google Scholar
41
-
Son K, Lee WS, Lee KB. Prediction of the learning curves of 2 dental CAD software programs. J Prosthet Dent. 2019;121(1):95-100. doi: 10.1016/j.prosdent.2018.01.004.
Google Scholar
42
-
Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016;21(4):125-7. doi: 10.1136/ebmed-2016-110401. Epub 2016 Jun 23. PMID: 27339128; PMCID: PMC4975798.
Google Scholar
43
-
Lin L, Chu H. Quantifying publication bias in meta-analysis. Biometrics. 2018;74(3):785-794. doi: 10.1111/biom.12817.
Google Scholar
44
-
Moser P. Out of control? Managing baseline variability in experimental studies with control groups. Handb Exp Pharmacol. 2020;257:101-117. doi: 10.1007/164_2019_280..
Google Scholar
45
-
Ioannidis JP, Patsopoulos NA, Rothstein HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ. 2008;21;336(7658):1413-5. doi: 10.1136/bmj.a117.
Google Scholar
46
-
Eysenck HJ. Meta-analysis and its problems. BMJ. 1994 Sep 24;309(6957):789-92. doi: 10.1136/bmj.309.6957.789.
Google Scholar
47
-
Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration. Int Endod J. 2020;53(7):922-947. doi: 10.1111/iej.13300.
Google Scholar
48
-
Hammel C, Pandis N, Pieper D, Faggion CM Jr. Methodological assessment of systematic reviews of in-vitro dental studies. BMC Med Res Methodol. 2022;22(1):110. doi: 10.1186/s12874-022-01575-z.
Google Scholar
49
-
Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J, Pulikkotil SJ, Dummer PMH. Guidelines for reporting the quality of clinical case reports in Endodontics: a development protocol. Int Endod J. 2019;52(6):775-778. doi: 10.1111/iej.13067.
Google Scholar
50
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