My dentist says I need a “dental pin” after root-canal treatment—what is it, and is it necessary?｜證據鏈

My dentist says I need a “dental pin” after root-canal treatment—what is it, and is it necessary?｜證據鏈

F-Units (fact-unit ledger)

• F1｜confidence: verified｜basis: law (Taiwan Medical Care Act Articles 21 and 22)｜period: current text; on 2026-08-06, `curl` retrieved the National Laws and Regulations Database article page with HTTP 200 and the article block was checked verbatim｜geo: TW｜span (Article 21, official English): “The standards for medical institutions to charge medical fees shall be approved by the competent authority of special municipality, county or city.”｜caveat: The article itself contains no item or price. This card does not quote the full text of Article 22; it only summarizes the receipt obligation in the checklist.
• F2｜confidence: verified｜basis: law (Taiwan Medical Care Act Articles 87 and 81)｜period: current text; on 2026-08-06, `curl` retrieved the National Laws and Regulations Database article page with HTTP 200 and it was checked verbatim｜geo: TW｜span (Article 87, official English): “The publishing of medical new knowledge or research reports, health education for patients and academic publications that do not involve soliciting medical business shall not be deemed medical advertisements.”｜span (Article 81, official English): “When treating a patient, a medical institution shall inform the patient or his legal representative, spouse, relative or related person of his condition, treatment policy, treatment, medication, prognosis and possible adverse reactions.”｜caveat: Article 87 is the basis for this card’s health-education positioning, not permission for medical advertising.
• F3｜confidence: verified｜basis: official_statement (NLM MeSH Post and Core Technique, UID 68011176; retrieved verbatim with E-utilities `efetch db=mesh` on 2026-08-06)｜period: Year introduced: 1991(1975)｜geo: universal｜span: 「Use of a metal casting, usually with a post in the pulp or root canal, designed to support and retain an artificial crown.」｜caveat: The definition describes a metal-casting form, reflecting the age of the heading. Current practice also has prefabricated fiber and customizable fiberglass forms (F10, F12, F13, F14), so when this card uses “post and core” it identifies both Taipei official items, cast and prefabricated (F7). The Chinese mapping “牙柱心” comes from the Taipei approved-fee item, not from this site.
• F4｜confidence: verified｜basis: official_statement (MeSH Orthodontic Anchorage Procedures, UID 68052280; retrieved verbatim with `efetch db=mesh` on 2026-08-06)｜period: Year introduced: 2006｜geo: universal｜span: 「Attachment of orthodontic devices and materials to the MOUTH area for support and to provide a counterforce to orthodontic forces.」｜caveat: This heading covers orthodontic anchorage procedures broadly; its Entry Terms do not include temporary anchorage device. The names miniscrew, mini-implant, microimplant, and temporary anchorage device used in this card come from F18’s literature search terms and are not asserted to be formal MeSH headings.
• F5｜confidence: verified｜basis: official_statement (MeSH Dental Implants, UID 68015921; retrieved verbatim with `efetch db=mesh` on 2026-08-06)｜period: Year introduced: 1990｜geo: universal｜span: 「Biocompatible materials placed into (endosseous) or onto (subperiosteal) the jawbone to support a crown, bridge, or artificial tooth, or to stabilize a diseased tooth.」｜verification record (Entry Terms from the same record, re-retrieved with `efetch db=mesh` on 2026-08-06): Dental Implant / Implant, Dental / Implants, Dental / Dental Prostheses, Surgical / Dental Implants, Mini / Dental Implant, Mini / Mini Dental Implant / Mini Dental Implants｜caveat: This is a device-category description, not an indication decision. This card only directs readers onward for this branch. Because the definition includes “or to stabilize a diseased tooth,” this branch must not be shortened to “replace a whole missing tooth,” and the presence or absence of a whole missing tooth must not be used to exclude a reader. The Entry Terms’ overlap with F18’s `Mini Dental Implant` search term does not mean the procedures are the same; distinguish them by the formal procedure name given by the dentist.
• F6｜confidence: verified｜basis: official_statement (medical-device classification database commissioned by Taiwan FDA; on 2026-08-06, checked in a live ego-browser session by entering each keyword and reading result rows)｜period: query status on 2026-08-06｜geo: TW｜verification record: Chinese query “牙釘” returned 0; “支抗” returned 0; “骨釘” returned 3 (F.4120 bone-cutting device and accessories, N.3030 single or multiple metallic bone-fixation devices and accessories, N.3480 constrained knee-joint femoral-tibial metallic cemented augmentation devices), with faceting F-dentistry 1 and N-orthopedics 2; “矯正” returned 15 (13 + 2 discontinued), including 4 F-dentistry records: F.0002 orthodontic planning software, F.3750 orthodontic bracket adhesive resin and conditioner, F.5470 plastic orthodontic brackets and aligners, F.5500 extraoral orthodontic headgear; “根管” returned 3, including F.3890 Endodontic stabilizing splint (grade 2), whose scope says it is a device made of material such as titanium, placed through a root canal into the upper or lower jaw to stabilize a tooth.｜caveat: The database itself says it is commissioned and maintained by the Taiwan FDA and is for reference, with FDA announcements controlling in case of discrepancy. No matching item does not mean that a procedure does not exist in Taiwan or is unlawful; it means only that the classification database has not recorded a corresponding item under that keyword. Scope descriptions describe device use, not clinical indications.
• F7｜confidence: verified｜basis: official_statement (Taipei City medical-institution dental-fee schedule, approved 1090117 version; PDF retrieved with `curl` on 2026-08-06: HTTP 200, 411,466 bytes, SHA256 33588b87…f98183, matching the same-day hashes recorded for KM-DENTAL-44 and KM-DENTAL-C03; checked verbatim after `pdftotext -layout`)｜period: approved on 109-01-17; approval number 北市衛醫字第 1093010058 號｜geo: TW｜span (item 2-48, cast post and core; unit per post; notice text, official Chinese):「1.本項費用含臨床操作及調整。2.不含診療費用。3.本項費用包含牙體技術師/士費用。4.依鑄造使用金屬不同而有所差異。」｜span (item 2-49, prefabricated post and core; unit per post; notice text, official Chinese):「1.本項費用含臨床操作及調整。2.不含診療費用。3.本項費用不包含牙體技術師/士費用。4.依現成牙柱心材質不同而有所差異。」｜span (note 3, official Chinese):「本表所列項目日後納為衛福部中央健保署醫療服務支付項目後，依「臺北市醫療機構醫療費用收費標準核定原則」規定辦理」｜verification record (full-text search): “牙釘” occurs 0 times; “釘” occurs 4 times, of which “骨釘” occurs 2 times and both are in oral-and-maxillofacial-surgery passages; the orthodontics section (items 3-50 to 3-81, consecutive numbering, 32 items) has no dedicated orthodontic-anchorage-miniscrew item. Further absence searches for Chinese terms equivalent to anchor, screw, small screw, micro, mini, implant screw, insert screw, anchorage, microimplant, and the English terms anchor/screw/TAD were all 0.｜caveat: This is an approved document for one city, not Taiwan-wide. This card cites no number from its price column. Absence of an item is only the state of this municipal approved document and must not be inferred as an NHI-coverage decision.
• F8｜confidence: verified｜basis: official_statement (same PDF as F7; extracted verbatim with `pdftotext`)｜period: same as F7｜geo: TW｜span (item 3-26, dental implant placement surgery, general; per tooth; official Chinese):「人工牙根植入技術費，不包含人工牙根材料費。」｜span (item 3-40, temporary implant surgery; per tooth; official Chinese):「基於維持美觀或咬合所需之暫時性植體置入及移除手術費，不包含暫時修復體與暫時性植體材料費。」｜caveat: Item 3-40 expressly states its purpose is maintaining aesthetics or occlusion; it is a temporary implant for prosthetic use and must not be read as an orthodontic anchorage device. These two items are cited only to distinguish official item names and purposes, never their price column.
• F9｜confidence: verified｜basis: official_statement (MeSH Bone Screws, UID 68001863; retrieved verbatim with `efetch db=mesh` on 2026-08-06)｜period: Year introduced: 1974(1971)｜geo: universal｜span: 「Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures.」｜caveat: Used to explain another common Chinese referent of “bone screw,” orthopedic fracture fixation; it is not the heading for an orthodontic anchorage miniscrew.
• F10｜confidence: verified｜basis: peer_reviewed (J Dent 2025 Aug;159:105739, systematic review and meta-analysis, PMID 40216072; abstract retrieved verbatim with `efetch rettype=abstract` on 2026-08-06; `esummary` pubtype checked with no Retracted Publication marker)｜period: searched to 2024-10; 13 randomized clinical trials included｜geo: universal｜span: 「Electronic database searches were conducted in MEDLINE/PubMed, Embase, Scopus, and Web of Science up to October 2024」｜span: 「Overall, restorations with posts showed significantly lower failure rates compared to those without posts (P = .001; Risk Ratio [RR]: 0.61). Subgroup analysis demonstrated favorable outcomes for post-use in indirect restorations (P < .001; RR: 0.44).」｜span: 「Further analysis revealed significant benefits only for prefabricated fiber posts (P < .001; RR: 0.54) and customizable fiberglass posts (P = .001; RR: 0.66). In contrast, cast post and core (P = .66; RR: 0.84) and prefabricated metallic posts (P = .67; RR: 1.19), showed no significant difference compared to restorations without posts.」｜span: 「The overall certainty of the evidence was classified as low due to the risk of bias, indirectness, and imprecision.」｜caveat: The direct-restoration RR 1.10 (P = .74) is the original report’s non-significant result and is retained as such. The authors’ clinical advice is a clinical material-selection judgment and is not rewritten as a reader self-selection rule. This is the most recent systematic review by search date for whether to place a post; F11 and F12 search earlier.
• F11｜confidence: verified｜basis: peer_reviewed (J Oral Sci 2024;66(4):207-214, systematic review and meta-analysis, PMID 39231718; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: electronic search had no time limit; 57 articles in qualitative analysis and 17 clinical studies in quantitative analysis｜geo: universal｜span: 「17 clinical studies (11 prospective and 6 retrospective studies) were found to be suitable for quantitative analysis. These studies included 7,278 patients (7,330 ETT)」｜span: 「There was a statistically significant difference in survival rate between ETT with or without posts (P < 0.001).」｜span: 「As compared with teeth with no posts, post placement on ETT may improve clinical performance and survival probability of endodontically treated teeth.」｜caveat: The authors say `may improve`; this card retains that tentative expression and does not rewrite it as certainty. The abstract reports neither a pooled effect size nor certainty assessment.
• F12｜confidence: verified｜basis: peer_reviewed (J Prosthet Dent 2025 Sep;134(3):597-615, systematic review and network meta-analysis, PMID 37827970; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched from database inception to 2022-11; 25 articles included｜geo: universal｜span: 「Fiber posts (RR=0.15 [95% CI: 0.06, 0.33]) significantly prevented tooth fracture as compared with no posts.」｜span: 「Metal posts (RR=0.24 [95% CI: 0.12, 0.46]) ranked higher than fiber posts (RR=0.39 [95% CI: 0.27, 0.56]) in the outcome of debonding.」｜span: 「Prefabricated glass fiber posts (RR=0.40 [95% CI: 0.20, 0.81]) had statistically significant differences in the outcome of secondary caries.」｜span: 「The GRADE approach determined a moderate level of certainty of evidence.」｜caveat: Network-meta-analysis rankings (SUCRA) are relative rankings, not an individual patient’s expected result. Different outcomes—fracture, debonding, and secondary caries—point in different directions and must not be combined or subtracted across outcomes. The authors also call for longer-follow-up trials to increase certainty.
• F13｜confidence: verified｜basis: peer_reviewed (J Prosthet Dent 2024 Apr;131(4):567-578, systematic review and meta-analysis, PMID 35430048; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: online publication 2022; print issue 2024; 7 randomized controlled clinical trials with at least 2 years of follow-up｜geo: universal｜span: 「Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.」｜span: 「Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.」｜caveat: 92.8% and 78.1% must be stated in the same sentence as “no statistical significance.” The abstract reports no difference or risk difference, so this card makes no subtraction or conversion. The abstract gives no search cutoff, so F10 and F12 provide the newer search-date basis for version comparison.
• F14｜confidence: verified｜basis: peer_reviewed (Quintessence Int 2019;50(1):8-20, systematic review and meta-analysis, PMID 30600326; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched to 2018-01; 4 randomized controlled trials with 3 to 7 years’ follow-up included｜geo: universal｜span: 「Fiber posts presented significantly higher survival rates than did metal posts (RR 0.57, 95% CI: 0.33 to 0.97, P = .04), while no difference was observed in success rates, post debonding rates, or root fracture rates.」｜span: 「when used in the restoration of endodontically treated teeth with no more than two coronal walls remaining」｜caveat: The abstract presents this comparison as RR 0.57 but does not spell out the event definition for that risk ratio. This card therefore quotes it and does not infer a numerator event. Its applicability is limited to cases with no more than two coronal walls remaining; the wording must not be omitted. This review’s search date precedes F10 and F12; this card treats the newer reviews as current primary evidence while retaining this condition.
• F15｜confidence: verified｜basis: peer_reviewed (J Prosthodont 2026 Apr;35(4):450-459, systematic review and meta-analysis, PMID 41601347; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: PRISMA 2020; 33 primary studies included (6 clinical, 18 in vitro, 9 finite-element)｜geo: universal｜span: 「To systematically review and meta-analyze clinical, in vitro, and finite-element studies assessing how ferrule height, width, and circumferential extent influence fracture resistance and survival of endodontically treated teeth.」｜span: 「Thirty-three primary studies (6 clinical, 18 in vitro, 9 finite-element) were included. Ferrule height ≥ 2 mm significantly improved fracture resistance (MD +165 N; 95% CI: 110-215). Ferrule presence increased clinical survival (RR 1.34; 95% CI: 1.12-1.59).」｜span: 「No restorative strategy matched the biomechanical reinforcement provided by a natural dentin ferrule.」｜span: 「These findings should be interpreted within the context of variation in study designs and reporting quality.」｜caveat: Most included studies are in-vitro or simulation studies (only 6 clinical of 33). The +165 N fracture-resistance result is mechanical-level evidence and must not be read as clinical effectiveness. The term `ferrule` is retained; it is a different anatomical concept from root furcation and they must not be interchanged.
• F16｜confidence: verified｜basis: peer_reviewed (J Prosthet Dent 2024 Dec;132(6):1251-1259, systematic review and meta-analysis, PMID 38216376; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: 8 studies included (randomized clinical trials and prospective cohort studies; follow-up at least 6 months)｜geo: universal｜span: 「Direct analysis of success rates (2 studies, 123 teeth) showed a significant increase in success when a uniform circumferential ferrule was present (RR=1.28, 95% CI: 1.06, 1.54, P<.05). However, indirect analysis of survival and success rates (8 studies, 407 teeth) indicated no significant differences in outcomes between the ferrule and no ferrule groups (P>.05).」｜caveat: Direct analysis has only 2 studies and 123 teeth, a very small sample. The same paper’s indirect analysis has no significant difference, so both must be presented; neither may be cited alone.
• F17｜confidence: verified｜basis: peer_reviewed (J Prosthet Dent 2019 Jun;121(6):887-894.e4, systematic review and meta-analysis, PMID 30617032; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: 6 studies included｜geo: universal｜span: “The risk ratio for anterior versus posterior teeth was 1.06 (95% confidence interval [CI], 0.69-1.64; P=.79). The risk ratio for incisors versus canines was 3.08 (95% CI, 0.56-17.04; P=.20) and that for premolars versus molars was 0.45 (95% CI, 0.12-1.74; P=.25). The risk ratio for prefabricated glass fiber posts on anterior versus posterior teeth was 1.13 (95% CI, 0.61-2.09; P=.70) and that for metal posts was 1.10 (95% CI, 0.64-1.91; P=.72).”｜caveat: Every listed confidence interval crosses 1, so none excludes no difference. No claim that anterior or posterior teeth fail more easily may rely on this paper. The authors’ conclusion is limited to short- to medium-term follow-up.
• F18｜confidence: verified｜basis: peer_reviewed (Orthod Craniofac Res 2025 Apr;28(2):217-241, systematic review and meta-analysis, PMID 39377777; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched MedLine/Cochrane/Web of Science/EMBASE and grey literature｜geo: universal｜span: 「The search terms used were "Orthodontic Anchorage Procedures," "mini-implant," "Mini Dental Implant," "Miniscrew," and "microimplant."」｜span: 「Miniscrews are small-sized intraoral devices used for temporary skeletal anchorage and are easy to place and remove.」｜span: 「Patients tend to overestimate the pain inherent in this procedure. The insertion of micro implants is more accepted than the tooth extraction procedure, with less postoperative pain reported.」｜span: 「The most frequent outcome reported is pain and discomfort, which varies depending on its location (less with mini interradicular screws than with extra-alveolar screws). Most patients are satisfied or very satisfied with this application.」｜caveat: The abstract is a non-structured narrative and gives no pooled pain quantity or heterogeneity. This card keeps findings at the authors’ narrative level and must not translate them into a no-pain or comfort guarantee. It mentions anaesthesia and surgical technique as factors affecting discomfort; those are clinical judgments and are not included in the body.
• F19｜confidence: verified｜basis: law (Taiwan National Health Insurance Act Article 51; law page retrieved by `curl`, HTTP 200, and checked verbatim on 2026-08-06) + official_statement (NHI Administration medical-device price-comparison-site item categories; cross-card verified fact under the same anchor, record in `km-compliance/VERIFIED-FACTS.md`)｜period: current legal text; price-comparison site checked on 2026-08-05 (not retested for this card)｜geo: TW｜span (Article 51 paragraph 3, official English meaning): non-drug-addiction treatment, cosmetic surgery, non-traumatic therapeutic orthodontics, preventive surgery, assisted reproductive technology, and gender-affirming surgery.｜span (Article 51 paragraph 11, official English meaning): dentures, artificial eyes, eyeglasses, hearing aids, wheelchairs, crutches, and other appliances without active therapeutic purpose.｜verification record (price-comparison site): in both query routes the item categories did not include dentistry, and visible page text did not include the Chinese character for tooth｜caveat: This card makes no coverage determination for any individual case. The article lists excluded items; individual determinations follow current NHI Administration rules and review. The price-comparison conclusion uses an existing cross-card record; the official database may change, so cite the verification date.
• F20｜confidence: verified｜basis: peer_reviewed (Clin Exp Dent Res 2025 Oct;11(5):e70220, umbrella meta-analysis, PMID 40919671; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched to 2024-10; 11 meta-analyses and 50 data sets included｜geo: universal｜span: “Eleven meta-analyses comprising 50 data sets were included. The results indicated that mini-screws significantly increased intermolar width (ES: 2.61 mm, 95% CI: 0.29-4.92, p = 0.02) and skeletal width (ES: 3.33 mm, 95% CI: 1.37-5.29, p = 0.001). However, no significant impact was found on interpremolar width or alveolar width before and after MARPE. Micro-implants significantly reduced molar movement (ES: -1.13 mm, 95% CI: -1.99 to -0.26, p = 0.01).”｜span (methods: CIs and heterogeneity are different quantities): “a random-effects model was used to calculate effect sizes (ESs) and 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² statistic and Cochrane's Q-test, with subgroup and sensitivity analyses conducted to identify sources of heterogeneity.”｜span (heterogeneity result): “Substantial heterogeneity was noted across several outcomes (I² > 50%), which persisted despite subgroup analyses.”｜caveat: Effect sizes are population-level averages, not individual expectations. A 95% confidence interval is uncertainty around the pooled-effect estimate, not a difference between people; inconsistency between studies is separately evaluated with I² and Q. This card labels `reduced molar movement` as original wording in an anchorage context and makes no extended interpretation.
• F21｜confidence: verified｜basis: peer_reviewed (J Evid Based Dent Pract 2020 Jun;20(2):101402, umbrella review, PMID 32473811; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: PROSPERO CRD42018094463; 17 systematic reviews and meta-analyses included｜geo: universal｜span: 「Most of the studies reported high success rates (≥90%), and just one systematic review indicated a low rate of success (≤56%) for the mini-screws.」｜span: 「The results should be analysed cautiously because of several research gaps related to the methodological quality and the high heterogeneity of the original studies」｜caveat: ≥90% and ≤56% are reported values from different reviews, not an interval for the same population. They must not be combined into a 56% to 90% success-rate range. This review searched earlier; F22 is used for site-specific detail.
• F22｜confidence: verified｜basis: peer_reviewed (Prog Orthod 2018;19(1):36, systematic review and meta-analysis, PMID 30246217; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched to 2017-10; 61 studies included｜geo: universal｜span: “Palatal sites had failure rates of 1.3% (95% CI 0.3-6), 4.8% (95% CI 1.6-13.4) and 5.5% (95% CI 2.8-10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4-11.4), 9.7% (95% CI 5.1-17.6) and 16.4% (95% CI 4.9-42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively.”｜span: 「The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3-23.6) and 9.9% (95% CI 4.9-19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1-14.7).」｜span: 「Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars.」｜caveat: `contacted the roots` means a screw contacted a neighbouring tooth root, not root furcation. `interradicular` means between roots, also not furcation. `midpalatal`, `paramedian`, and `parapalatal` are retained, not assigned invented Chinese terms. Evidence for the site-specific rates is very low to low; only root contact is moderate. A PubMed search for same-topic systematic reviews from 2019 to 2026 found no updated replacement for this site-specific failure-rate synthesis.
• F23｜confidence: verified｜basis: peer_reviewed (Orthod Craniofac Res 2021 Mar, systematic review and meta-analysis, PMID 33277824; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: searched to 2020-06; 7 studies finally included from 5734｜geo: universal｜span: 「The overall mean success rate weighted by the number of miniscrews was 87.21% (89.87% in the maxilla and 79.24% in the mandible). There was a significantly higher success rate for miniscrews placed in the maxilla compared with those in the mandible (P < .05).」｜span: 「Because of the small number and clinical heterogeneity of the included studies, the results should be interpreted with caution.」｜caveat: 87.21% is an overall average weighted by miniscrew count, not any individual’s chance of success. Only 7 studies were included and clinical heterogeneity was high; the authors themselves advise caution.
• F24｜confidence: verified｜basis: peer_reviewed (Clin Oral Investig 2022 Jan;26(1):65-82, systematic review and meta-analysis, PMID 34676428; `efetch` checked verbatim on 2026-08-06; pubtype had no retraction marker)｜period: 7 studies included in quantitative synthesis; evidence certainty assessed with GRADE｜geo: universal｜span: 「When comparing the risk of failure between mini-implants and mini-plates, the risk values approached the threshold of statistical significance (p = 0.07) (RR = 1.83; 95% CI = 0.96-3.50; I2 = 69%), showing significance after sensitivity analysis (p < 0.05) and a greater risk for mini-implants. Mandible installation presented a higher risk of failure (RR = 1.85; 95% CI = 1.17-2.91).」｜caveat: For RR 1.83, the 0.96–3.50 confidence interval crosses 1 and p = 0.07 does not meet the significance threshold; significance appeared only after sensitivity analysis. This must not be rewritten as an unconditional claim that mini-implants have higher failure risk. For mandibular RR 1.85, the confidence interval does not cross 1.
• F25 [structural synthesis]｜The three-way communication structure (post and core / orthodontic miniscrew / artificial tooth root), “first ask which one, then ask whether to do it,” the four-post-material reviews’ framework that different failure definitions cannot be subtracted, repeated distinction between population level and individual expectation, the two-tier care-seeking layout (airway red flags first, five other items after), the eight checklist questions, and the statement that the third branch only directs onward are this site’s communication framework synthesized from F3 to F24｜source #25｜confidence: n/a｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜caveat: Not a diagnostic tool or clinical decision process and must not be labelled verified. This entry contains no claim of effectiveness, timing, or safety. The instruction that choking/coughing, breathing difficulty, inability to speak, or chest pain after a device or fragment falls out is an emergency requiring immediate care, and that the airway is checked before the clinic is contacted, is this site’s conservative care-seeking instruction—not a threshold set by a cited study in this card. This card cites no original swallowing/aspiration paper; that literature anchor is in related KM-DENTAL-38 and KM-DENTAL-30 cards, with #38 in this card’s internal link chain and #30 not listed. This red flag deliberately gives no observation duration or time threshold, and translation or revision must not add one. After a same-project C07 comparison on 2026-08-06, it was revised from item 4 only into a separate front red-flag section at the same level as C07.
• F26 [structural synthesis]｜This card’s terminology approach: `post and core` uses the Taipei approved-fee item name “牙柱心” (F7); `ferrule` is retained and expressly distinguished from root furcation; `miniscrew` / `mini-implant` / `microimplant` / `temporary anchorage device` are described as orthodontic miniscrews with original terms (F18); `midpalatal` / `paramedian` / `parapalatal` / `zygomatic buttress` / `interradicular` are retained (F22). Mapping the Taipei fee items “鑄造牙柱心” and “現成牙柱心” (F7) to the literature terms `cast post and core` and `prefabricated post` (F10, F12) is this card’s terminology mapping. The schedule itself does not state fabrication process, fit, or English translation; a prior claim that its official wording did so was corrected after CX adversarial review on 2026-08-06｜source #25｜confidence: n/a｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜caveat: The mapping is an editorial decision, not an officially announced translation. Cite each source’s original wording.
• F27｜Topic-selection basis = full GSC reconciliation: exact-match Chinese query 「牙釘」 in the `` web detail had 765 rows, 4,094 total impressions, and 27 clicks (rerun with `awk` against `gsc-full-20260804/__web__full.tsv` on 2026-08-06; matches the `km-production-queue.html` supplementary-topic table). The same site’s query family also contained terms for dental-pin price, post price, glass-fiber dental-pin cost and disadvantages, material, implant screw, and bone screw; the three meanings coexist in real search data｜source #24｜confidence: verified｜basis: internal_dataset｜period: GSC retention window (from 2025-03-22)｜geo: TW｜caveat: Impressions are asset-level, not deduplicated traffic. The placement list follows the 「牙釘」 row of the queue table and must not be added to or reduced. This is internal data, not a medical claim; omit the entire entry when converting for publication.

Sources

All accessed on 2026-08-06. PubMed abstracts were obtained with E-utilities `efetch` (`rettype=abstract`) and checked verbatim; `esummary` pubtype was checked item by item for retraction status (14 records: no Retracted Publication marker and no WITHDRAWN title). MeSH scope notes were retrieved with `efetch db=mesh`; law text was retrieved from the National Laws and Regulations Database with `curl` (HTTP 200) and the article block checked verbatim; the Taipei fee-schedule attachment was separately downloaded with `curl` and extracted with `pdftotext -layout` for verbatim comparison (size and hash in F7); the medical-device classification database was checked in a live ego-browser session by running each keyword and reading result rows.

• S1 Taiwan Medical Care Act, Article 21. National Laws and Regulations Database L0020021 Article 21
• S2 Taiwan Medical Care Act, Article 22. National Laws and Regulations Database L0020021 Article 22
• S3 Taiwan Medical Care Act, Article 81. National Laws and Regulations Database L0020021 Article 81
• S4 Taiwan Medical Care Act, Article 87. National Laws and Regulations Database L0020021 Article 87
• S5 Taiwan National Health Insurance Act, Article 51. National Laws and Regulations Database L0060001 Article 51
• S6 Taipei City Department of Health fee standards: “Taipei City Medical Institution Dental Fee Schedule” (approved 1090117). health.gov.taipei fee-standard page　[On the official page the label appears in Chinese only: 「臺北市醫療機構牙科收費標準表」]
• S7 Taipei City Medical Institution Dental Fee Schedule (approved 1090117) PDF attachment. www-ws.gov.taipei attachment
• S8 Medical-device classification database (commissioned by Taiwan FDA). mdlicense.itri.org.tw classification search
• S9 National Health Insurance Administration medical-device price-comparison-site item categories, two query routes (cross-card verified fact). info.nhi.gov.tw INAE2000/INAE2010S01 (checked in ego-browser by KM-DENTAL-03 on 2026-08-05 and rechecked by OP; record in `km-compliance/VERIFIED-FACTS.md`; not retested for this card)　[On the official page the label appears in Chinese only: 「醫材比價網」]
• S10 NLM MeSH: Post and Core Technique. MeSH UID 68011176
• S11 NLM MeSH: Orthodontic Anchorage Procedures. MeSH UID 68052280
• S12 NLM MeSH: Dental Implants. MeSH UID 68015921
• S13 NLM MeSH: Bone Screws. MeSH UID 68001863
• S14 Jardim JS, et al. Is the use of an intraradicular post essential for reducing failures in restoring endodontically treated teeth? A systematic review and meta-analysis. J Dent. 2025;159:105739. PMID 40216072. PubMed
• S15 Alenezi AA, et al. Clinical behavior and survival of endodontically treated teeth with or without post placement: a systematic review and meta-analysis. J Oral Sci. 2024;66(4):207-214. PMID 39231718. PubMed
• S16 Giok KC, et al. Comparative effectiveness of fiber and metal posts in the restoration of endodontically treated teeth: A systematic review with network meta-analysis. J Prosthet Dent. 2025;134(3):597-615. PMID 37827970. PubMed
• S17 Tsintsadze N, et al. Comparing survival rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts: A systematic review and meta-analyses. J Prosthet Dent. 2024;131(4):567-578. PMID 35430048. PubMed
• S18 Wang X, et al. Evaluation of fiber posts vs metal posts for restoring severely damaged endodontically treated teeth: a systematic review and meta-analysis. Quintessence Int. 2019;50(1):8-20. PMID 30600326. PubMed
• S19 Hajeer O, et al. Ferrule dimensions and restoration outcomes in endodontically treated teeth: A systematic review and meta-analysis. J Prosthodont. 2026;35(4):450-459. PMID 41601347. PubMed
• S20 Al-Dabbagh RA, et al. Effect of a circumferential ferrule on the survival and success of endodontically treated teeth restored with fiber posts: A systematic review and meta-analysis. J Prosthet Dent. 2024;132(6):1251-1259. PMID 38216376. PubMed
• S21 Garcia PP, et al. Do anterior and posterior teeth treated with post-and-core restorations have similar failure rates? A systematic review and meta-analysis. J Prosthet Dent. 2019;121(6):887-894.e4. PMID 30617032. PubMed
• S22 Vale F, et al. Patient's Perspective on Miniscrews During Orthodontic Treatment—A Systematic Review With Meta-Analysis. Orthod Craniofac Res. 2025;28(2):217-241. PMID 39377777. PubMed
• S23 Jamilian A, et al. The Impact of Mini-Screws and Micro-Implants on Orthodontic Clinical Outcomes: An Umbrella Meta-Analysis. Clin Exp Dent Res. 2025;11(5):e70220. PMID 40919671. PubMed
• S24 Ramírez-Ossa DM, et al. An Umbrella Review of the Effectiveness of Temporary Anchorage Devices and the Factors That Contribute to Their Success or Failure. J Evid Based Dent Pract. 2020;20(2):101402. PMID 32473811. PubMed
• S25 Mohammed H, et al. Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants: a systematic review and meta-analysis. Prog Orthod. 2018;19(1):36. PMID 30246217. PubMed
• S26 Lee DW, et al. Cortical bone thickness and bone density effects on miniscrew success rates: A systematic review and meta-analysis. Orthod Craniofac Res. 2021;24 Suppl 1. PMID 33277824. PubMed
• S27 de Mattos PM, et al. Risk factors associated with the stability of mini-implants and mini-plates: systematic review and meta-analysis. Clin Oral Investig. 2022;26(1):65-82. PMID 34676428. PubMed

Internal link chain

• Upstream topic (the issue before this card): What is root-canal treatment? Why is the nerve removed? (KM-DENTAL-18, draft). That card covers root-canal treatment; this card continues with how the tooth may be supported. The canonical boundary is root-canal process in #18 and post/core/support structure here.
• Downstream topic (the crown above the core): What is a dental crown, and when is one needed? (KM-DENTAL-23, draft). Crown types, materials, and indications are in #23; this card only covers their support relationship to a post and core.
• Another path when tooth structure is insufficient: What is crown-lengthening surgery? (KM-DENTAL-17, draft). The procedure mentioned when this card discusses how much tooth remains is covered there.
• Adjacent topic (fracture at the root): What happens with a root fracture? Is extraction always necessary? (KM-DENTAL-C02, draft). This card cites root-fracture rates as failure types without expanding clinical management; management belongs to C02.
• Adjacent topic (when something falls out): A crown or appliance fell out—can I glue it back myself? (KM-DENTAL-38, draft). It expands on action item 1 in “When to contact the clinic promptly.”
• Destination for the third meaning of “dental pin”: What is the dental-implant process? (KM-DENTAL-25, draft). This card only disambiguates and defines the artificial tooth root; workflow, aftercare, and fee composition remain in the implant series.
• Related orthodontic card: How much does clear-aligner orthodontics cost, and how is the fee composed? (KM-DENTAL-C03, draft). Both cards use the same Taipei fee-schedule PDF, with the same-day hash record. C03 reads its orthodontics-section structure; this card reads the prosthodontic post-and-core items and the verified absence of an orthodontic-anchorage-miniscrew item.