Association of Age and Gender to Custom Made Cast Post Given as Post Endodontic Restoration

Keywords

Custom Cast Post; Endodontic Restoration; Fibre Post; Post and Core Technique.

Introduction

Grossly decayed endodontically treated tooth with less coronal tooth structure remaining either due to a large pre-existing restoration or an extensive access at any preparation often pose a challenge while choosing an appropriate post-endodontic restorative material [1]. Clinicians always face the dilemma of whether to go for a direct/ indirect restoration, partial/full coverage crown, whether to go for post or not [2, 3].

An advanced stage of a tooth decay promotes an extremely damaged tooth that needs endodontic treatment to be restored [4]. When satisfactory coronal tooth structure remains, an artificial crown can be placed without a post [5, 6]. On the other hand, the treatment of severely damaged teeth often requires an endodontic post.[7] The main reason for using post is to enable rebuilding of the tooth structure prior to crown restoration. [8-10] The fundamental requirements of posts include high tensile strength, high fatigue resistance to occlusal and shear loading and a good distribution of the forces affecting the tooth root [11, 12].

The primary purpose of a post is to retain a core in a tooth with extensive loss of coronal tooth structure [13 -15]. According to Franklin Weenie, most of the endodontically treated teeth often failed following root canal treatment owing to poor post endodontic restoration rather than primary endodontic cause [16].

Dentists believe that endodontic posts provide a stable and solid restoration of the tooth, as well as provides strengthening of the tooth root, which constitutes the solid basis for a dental crown restoration [17, 18]. However, some authors reported that the strength of the tooth is directly related to the remaining dentin, and because of that, an endodontic treatment can present a higher risk of biomechanical failure [19, 20].

A wide variety of post systems are available ranging from traditional cast metal posts to newer fiber posts [21]. The ease of use, less time consumption for fiber posts validates the utilization of fiber posts as an alternative to metal posts [22]. It doesn’t mean custom made cast posts have lost their relevance in today’s clinical practice.

Custom made cast posts are still a better option in cases where change in the angulation of the core is required and where there is more tooth structure loss [23]. Remaining coronal tooth structure following root canal therapy, functional requirements of the tooth, esthetics, age of patient and the existing periodontal condition have to be kept in mind while choosing an appropriate post endodontic restoration material [24].

Literature search reveals studies assessing the advantages of cast posts. However, there are no studies assessing the association of custom made cast post in various age and sex groups. To address this lacunae, this research was undertaken to assess the association of custom made cast post given as post endodontic restoration in various age and sex groups.

Previously our team has a rich experience in working on various research projects across multiple disciplines [25-39]. Now the growing trend in this area motivated us to pursue this project.

Materials And Methods

The present retrospective study was conducted among outpatients reported to the Department of Endodontics, Saveetha Dental College and Hospitals, Chennai from June 2019 to March 2020. A total of 80 patients who had given custom made cast posts as post endodontic restoration were recruited as study participants. Data regarding gender and the teeth with custom made cast posts were collected and analysed. The study protocol was approved by Institutional Ethics and Review Board, Saveetha Dental College and Hospitals, Chennai.

The collected data was then entered in Microsoft Excel spreadsheet and analysed using SPSS software (IBM SPSS Statistics, Version 23). Descriptive statistics and inferential statistics was done for data summarization and presentation. Correlation analysis was done between age, gender and custom made cast post restoration as post endodontic restoration.

Results & Discussion

The study consisted of 80 patients with a mean age of 36.9 ± 13.6 years. Among 80 patients, 65% were males and 35% were females. (Figure 1) The association between gender and the teeth with custom made cast posts was studied. The association was found to be not statistically significant (p = 0.693). (Figure 3) At the same time, 47.5% of the patients belong to 15-34 years, 41.25% belong to 35-54 years and 11.25% belong to 55-74 years who underwent post endodontic restoration with custom made cast post. (Figure 2) The association between age and the number of post endodontic restoration was also not statistically significant (p=0.124). (Figure 4) In the present study, males were predominantly given custom made cast posts as post endodontic restoration compared to females and patients in the age group of 15 to 34 years old were having maximum number of cast post restorations but there was no statistically significant association between age or sex either. The present study was conducted to assess the association of age and gender to custom made cast posts given as post endodontic restoration. In the present study, among 80 patients with cast post as post endodontic restoration, 28 (35%) were females and 52 (65%) were males. Hence, males were predominantly given cast post as post endodontic restoration. This finding is in accordance with the previous study by Lynch D et al, in which the influence of coronal restoration type on the survival of endodontically treated teeth was assessed. In that study also the common gender in custom made cast post category was males [40].

To the best of our knowledge, this is the first study to assess the association of age, gender and custom made cast post given as post endodontic restoration. There are studies assessing the survival rate, influence of ferrule and risk factors of various endodontic restoration systems. However, this is the first study of its kind.

In the present study, the common age group was 15-34 years and the association between age and the cast post restoration is found to be statistically not significant (p=0.124). This is in contrary to the previous study by Hollanda AC et al, [41] where the common age group of patients with custom made cast posts was 46-60 years. This difference might be due to traumatic injuries which are prominent in the younger age group or because of ethnicity as the previous study was conducted among Brazilian population. Also in the present study the association between age and gender to the cast post restoration is found to be statistically not significant (p=0.124 and 0.693 respectively). This is in contrary to the previous study by Hollanda AC et al, [41] where significant association was observed. This might be because of the limited sample size of the present study.

To generalise the findings, however, more studies are required in this field among the larger sample size. Also extensive research is needed to assess the other factors determining the choice of post given as post endodontic restoration.

Our institution is passionate about high quality evidence based research and has excelled in various fields [29], [42-51].

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Figure 1:

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Figure 1: Bar chart showing distribution of gender with number of patients with custom made cast post. X-axis represents gender Female(blue) and male (green) and Y-axis represents the number of patients with custom made cast posts. 35% were females and 65% were males. Males were predominantly given custom made cast posts as post endodontic restoration compared to females.

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Figure 2:

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Figure 2: Bar chart showing distribution of patient’s age with number of custom made cast posts. X-axis represents age groups [15-34 years(green), 35-54 years(purple) and 55-74 years(yellow)] and Y-axis represents the number of patients. 47.5% belong to 15-34 years, 41.25% belong to 35-54 years and 11.25% belong to 55-74 years. Patients belonging to 15-34 years were predominantly given custom made cast posts as post endodontic restoration followed by 35-54 years of age.

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Figure 3: Bar graph depicts correlation between gender and number of teeth with custom made cast post. X-axis represents gender and Y-axis represents number of teeth with custom made cast posts.Pearson Chi square value - 12.520, df - 15, p = 0.639 (>0.05) which was statistically not significant, However custom made cast posts were predominantly given in relation to upper central incisors in male particularly in tooth no 11.

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Figure 4:

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Figure 4: Bar graph depicts correlation between age groups and number of teeth with custom made cast post as post endodontic restorations. X-axis represents age groups and Y-axis represents the number of teeth with custom made cast posts. Pearson Chi square value - 39.088, df - 30, p = 0.124(>0.05) which is statistically not significant, However maximum number of custom made cast posts were done in the age group of 15 to 34 years.

Conclusion

Within the limitations of the study, it can be concluded that males (65%) were predominantly given custom made cast posts as post endodontic restoration compared to females(35%) and patients with age groups of 15 to 34 years(47.50%) were involved mostly in post endodontic restoration with custom made cast post compared to other age groups.