R

E

S

E

A

R

C

H

ABSTRACT
Background. The clinical decision as to whether an endodontically treated (ET) tooth requires a post and a crown poses a challenge to dental practitioners. The author conducted a review of the principles for the use of post and core and the newer materials such as ceramic and fiber-reinforced posts. Types of Studies Reviewed. Using a MEDLINE search and resulting cross-references, the author selected original research articles and previous review articles on the topic of ET teeth, as well as that of post and core. Results. The author reviewed the principles for the use of posts in terms of when it is necessary to use a post, different types of posts, various post materials and designs. He also reviewed the criteria and technique for post space preparation and post cementation. Finally, he discussed the principles of core buildup, as well as options for the final restorations. Clinical Implications. The author provides a review of the principles for the use of post and core, crowns and the different materials available today to help clinicians make a clinical decision based on sound evidence. Key Words. Post; core; endodontically treated teeth; fiber-reinforced post.

A review of the management of endodontically treated teeth
Post, core and the final restoration
WILLIAM CHEUNG, D.M.D.

n a separate article that describes the basic concepts in restoring endodontically treated (ET) teeth, I mentioned that endodontic treatment is performed often and that there is a high demand for the restoration of ET teeth.1 Some of the basic, yet important, concepts in the management of ET teeth are microleakage, the ferrule effect and biological width. It generally is agreed that the successful treatment of a badly broken down tooth with pulpal Restoration of disease depends not only on good endodontic therapy, but also on good teeth after prosthetic reconstruction of the tooth endodontic after endodontic therapy is completed. treatment is In this article, I review the principles becoming an in the use of a post, including when to integral part of use a post, types of posts, post materials, the restorative post design, post space preparation in terms of length and width, and the practice in cementation of a post. I also discuss the dentistry. principles in core buildup and the options available in final restorations.

I

PRINCIPLES IN THE USE OF A POST

Do posts strengthen ET teeth? It has been suggested that ET teeth dry out over time2 and that the dentin in ET teeth undergoes changes in collagen cross-linking.3 Therefore, it has been suggested that ET teeth are more brittle and may fracture more easily than non-ET teeth.4-6 It is believed that it is the loss of tooth structure from caries, trauma or both that makes ET teeth more

susceptible to fracture.7,8 Some clinicians believe that a post should be placed into the root after endodontic treatment to strengthen or reinforce it. Some studies, however, point out that posts do not strengthen teeth, but instead that the preparation of a post space and the placement of a post can weaken the root and may lead to root fracture.9-12 These studies further suggest that a post should be used only when there is insufficient tooth substance remaining to support the final restoration. In other words, the main function of a post is the retention of a core to support the coronal restoration. Perhaps using new adhesive materials and technology, clinicians can bond the post securely to the dentin in the root canal space, the core to the post and the final
May 2005 611

JADA, Vol. 136 www.ada.org/goto/jada Copyright ©2005 American Dental Association. All rights reserved.

the post does not make the tooth stronger. as the metal shows through the newer all-ceramic restorations. When to use a post. and yet it has good compressive strength that can withstand normal occlusal forces. One six-year retrospective study17 reported a success rate of 90. the clinical crown of the mandibular first premolar often is inclined lingually in relation to its root. These anatomical characteristics must be considered carefully during post space preparation to avoid perforating the root. All rights reserved. and posts are required more often in premolars. placement of pins can be considered for additional retention.5 × 106 psi) and coefficient of thermal expansion (≈ 15 [C–1] × 106) similar to those of enamel.10. material) are available. Most teeth require endodontic treatment as a result of trauma. Furthermore. However.10.R E S E A R C H restoration to the core and tooth. Custom-fabricated cast gold post and core has been used for decades as a foundation restoration to support the final restoration in ET teeth. With all components having similar physical properties successfully bonded together. The practice of endodontic therapy prefers an access cavity preparation that gives endodontic instruments “straight line” access into the canal space. which makes post space preparation difficult. and some have proximal root invaginations. design. Its major disadvantage. extensive caries or restoration. Other base metal alloys have been used. Many types of prefabricated posts (in terms of shape.9. the evaluation of whether a post is needed is based on how much natural tooth substance remains to retain a core buildup and support the final restoration after caries removal and endodontic treatment are completed. is esthetics.org/goto/jada May 2005 Copyright ©2005 American Dental Association.13 the decision whether to use a post in any clinical situation must be made judiciously. a post may be necessary to retain the core so that these teeth can resist functional forces. If an anterior tooth must be prepared to receive a crown after endodontic treatment because a good amount of tooth structure was lost. . as they have thin roots in the mesiodistal dimension.12 These teeth may be restored conservatively with a bonded restoration in the access cavity.18 Another disadvantage of the cast post and core placement procedure is that it requires two visits and laboratory fabrication. it should be placed in the largest and straightest canal to avoid weakening the root too much during post space preparation and root perforation in curved canals. Types of posts.15 Should tooth discoloration become a concern.6 percent using a cast post and core as a foundation restoration. along with the concept of “crown down” in endodontic therapy. This. whitening and placement of veneers can be considered. Many practitioners prefer to use a cast gold post and core for ET anterior teeth. There are two main categories of posts: custom-fabricated and prefabricated.14 Premolars have less tooth substance and smaller pulp chambers to retain a core buildup after endodontic treatment than do molars. Since a post does not strengthen an ET tooth and the preparation of a post space may increase the risk of root fracture and treatment failure. 136 A few studies have concluded that a post is not necessary in an ET anterior tooth with minimal loss of tooth structure. 612 JADA. Many ET molars do not require a post because they have more tooth substance and a larger pulp chamber to retain a core buildup. and I will discuss them later in the article. dentistry can say only that a post is used primarily to retain a core in a tooth with extensive loss of structure. A photoelastic stress analysis of post design led to the conclusion that cement-retained posts and www. An alternative is a prefabricated post that can be adjusted and inserted in a single visit. The distal canal of mandibular molars and the palatal canal of maxillary molars usually are the best canals for post placement. In addition to root taper and curvature. many premolar roots are thin mesiodistally. Special care must be exercised when placing posts in mandibular incisors. When core retention still is insufficient after a single post is inserted. Cast gold alloy (type III or IV) is an inert material with modulus of elasticity (stiffness of 14.14 When a post is required as a result of extensive loss of natural tooth substance. dentistry may be able to claim that a post can strengthen and reinforce the root. since a study by Baratieri and colleagues16 concluded that the use of posts did not improve the fracture resistance of ET maxillary incisors that received veneers with direct composite. Therefore. Vol. One way to overcome this is to make a porcelainfused-to-metal post and core from a metal ceramic alloy to mask the shade of the metal. means that more sound coronal and radicular dentin must be removed for efficient cleaning and shaping of the root canal system. however.ada. but their hardness might be a major disadvantage in adjustment and may predispose the tooth to root fracture.

Stainless steel and brass requires less dentin removal to accommodate a have problems with corrosion. their post space preparation. Another newer type of post is the fiberthe use of tapered posts requires removing less reinforced polymer post. especially under allsufficient retention within the root is difficult. Ceramic has good biocompatibility.27. which usually is an epoxy resin. to those of dentin. This can be undesirincluding braided.R E S E A R C H parallel posts were the least stressful to the root. able. In addition. Pure titanium has shorter and thinner post and leads to lower susslightly lower physical properties such as in comceptibility to tooth fracture.28. resin tags and an adhesive lateral prefabricated posts. evaluation has shown clearly the formation of a Stainless steel has been used for a long time in hybrid layer. especially in post space preparation for parAccording to two in vitro studies.32-34 Scanning electron microscopic (SEM) in more detail later. more dentin removal is required in available in a number of different configurations. but it also means that the shape (parallel versus is the least corrosive and most biocompatible tapered) of the fiber-reinforced post may be less material. however. measures closer to that of should have physical properties— such as modulus of elasticity.28 the physical allel posts. titaforces without distortion to the nium and titanium alloys. They offer JADA. May 2005 613 . comdentin (≈ 2 × 106 psi) and can with stainless steel pressive strength and coefficient of decrease the incidence of root fracposts during removal thermal expansion—that are similar ture. high exert more stress on the root and should be conflexural strength and fracture toughness. ceramic crowns. posite core materials. In vivo bonding of fiberno such material is available to date even though reinforced posts to the dentinal wall of the root fiber-reinforced posts look promising. prewhen restored with fiberfabricated posts should not be corroreinforced posts. Stainless steel.25.20 Successful bonding pressive and flexural strength than alloys.29 In the event of failure in retreatment cases. Vol.35 removal in retreatment cases. I discuss it canal space using resin cement has been demonstrated. most Since fiber-reinforced posts are metal-free. which makes them more difficult to screw-type posts offer more retention.22-24 and sidered only in short roots in which obtaining it is esthetically pleasing.19 Certain graphs. and long-term clinical space so that shorter posts may be used. ceramic and fiberhigher chance of root fracture. goldless rigid dentin and lead to a plated brass. Successful bonding minimizes the and nickel sensitivity is a concern. The highly rigid metal would transfer lateral Materials. However. fiber-reinforced posts (between and tend to break The ideal post and core material 1 and 4 × 106 psi). In regard to conservation of tooth structure. two in vitro studies Pontius and Hutter20 speculated that the sucreported poor resin-bonding capability of ceramic cessful bonding of fiber-reinforced posts may posts to dentin under fatigue testing. as more dentin is removed from the strength of fiber-reinforced post is significantly thinner apical and middle aspects of the root weaker than that of cast metal posts and cores. woven and longitudinal. Unfortunately. Titanium posts have reinforced polymers have been used The lower flexural modulus of low fracture strength as materials for prefabricated posts.ada. Although parallel resin. especially wedging effect of the post within the root canal. branch. it contains nickel. All rights reserved. 136 www. they titanium alloys used in posts have a density simdo not cause metal allergies or corrode. Furthermore. It is made of carbon or dentin because root canal spaces are cleaned and silica fibers surrounded by a matrix of polymer shaped in a tapered fashion. but they detect.27. results are not yet available. among female patients.21 Titanium posts. have low fracture strength and tend to break more easily significant in relation to its retention than for a compared with stainless steel posts during metal post. ilar to that of gutta-percha when seen on radiobut they also were the least retentive. canal walls. on the other more easily compared hand.30. However.26 This type assist in the retention of posts in the root canal of post is relatively new.31 strongly to dentin inside the root using suitable Fiber-reinforced posts are fabricated to bond cement so that the entire assembly of a post and with most resin cements and resin-based comcore resembles the original tooth. The fibers posts and screw posts are more retentive in the are 7 to 10 micrometers in diameter and are root canal. teeth are more sive and should bond easily and likely to be restorable.org/goto/jada Copyright ©2005 American Dental Association.

and transfer more stress to the remaining root dthe post should extend to one-half the length of structure. or threaded using gutta-percha by heat pluggers folKnowing the root taps or self-threading. post drill. It is not difinstallation. increased matched cylindrical channels prepared by a post post length also increases risk of fracture and perforation of the remaining root. Gutmann40 gave a good review of to six years reported a failure rate of only 3. can be used routinely in combination with Dentists often use mechanical preparation bonding materials. With dthe post length should be equal to the clinical respect to their installation mode. cemented into retentive it is. the appropriate post length and width to avoid especially under the all-ceramic crowns and root perforation. so the preparaattempting to prepare any canal space for post tion of the post space must be evaluated carefully installation.org/goto/jada May 2005 Copyright ©2005 American Dental Association. 136 www. For instance. referred to as either active or passive. proximal root invaginaremoved easily in case of an endodontic failure tions. Finally. many commercially available prelow speed are the safest instruments. Caputo and lowed by the post drill should be anatomy of different Standlee39 categorize these considered by inexperienced operateeth is important different design features into three tors to minimize the risk of basic combinations: perforation. Active dthe post length should be equal to one-half to posts engage dentin within the root canal space two-thirds of the length of the remaining root4. still As I stated previously.41 Use of one fabricated posts exist. Clinicians must conPost space preparation. Many authors have to prepare any canal sided. and threaded posts post length include the following: are more retentive than cemented posts. fiber-reinforced posts can be tions such as root taper. before attempting dtapered. aware that root diameter may differ in the facialPost width. the axial form of these instruments should precede the use of is either tapered or parallel. For example. ficult to understand that the longer dparallel-sided. anatomy of different teeth is important before Each clinical situation is unique. all posts are crown length46.ada. Passive posts.49 engage dentin in the root canal space. serrated or smoothPost length.48. . A combination of removing without vents. clinicians must consider condibridges. root anatomy varies transfer stress to the remaining root structure. even though they do not the root that is supported by bone.36 Two other retrospective techniques for post spaces because it is faster. threaded and inserted into preaccepted that the apical 3 to 6 mm of guttatapped channels. parallel-sided posts are more seal. serrated or the post in the canal. dparallel-sided.47. percha must be preserved to maintain the apical In general.43-45 Acceptable guidelines for determining the retentive than tapered posts.38 Like the the apical seal. it has been established that Post designs. the more smooth-sided.2 peranatomical and biological considerations in cent.37.R E S E A R C H good esthetics in easily visible areas of the mouth. and data on their long-term clinical performmore time-consuming. Knowing the root sider these variations along with the guidelines. In addition to the custom cast Gates-Glidden drills and P-type reamers used on post and core.39 tooth in different patients. All rights reserved. It is accepted widely that the post lingual and mesiodistal dimensions. studies up to four years long also reported a sucMechanical preparation is associated with a cess rate of approximately 95 percent using fiberhigher risk of root perforation and may disturb reinforced posts to restore ET teeth. and the surface can any post drill that comes with the prefabricated be smooth. serrated with or post kit. fiber-reinforced posts are relatively gutta-percha using heat pluggers is safer but new. from tooth to tooth and even within the same but to a lesser extent. However. cemented into a post space offered guidelines for determining space for post prepared with a matched-size the desired post length.42 It generally is drill. When mechanical preparaance are not available yet. Vol. The thermal method of removing ceramic posts. tion is preferred. To determine diameter makes little difference in the retention of 614 JADA. clinicians must be and planned for accordingly.30 One study that evaluthe root during the mechanical preparation of a ated three types of fiber-reinforced posts over one post space. and the authors concluded that these posts restoring ET teeth. root curvatures and angle of the crown to requiring re-treatment.

52. is not encountered if fiber-reinforced posts are used in combination with resin cement. Resin-based composite. Bonding resin cement to the dentinal wall of the root canal space must be done carefully to improve bonding and minimize microleakage. followed by cleansing the walls using a long Peeso brush with pumice slurry. Post cementation.57. dental practitioners must keep in mind that though preliminary studies on the use of these materials are promising. This problem. This can be accomplished by removing gutta-percha using thermal methods. Other methods of preparing the canal walls for bonding also have been suggested. as long as the canal walls are cleaned thoroughly. have demonstrated improved retention of posts54-57 and decreased microleakage58-60 and higher fracture resistance of teeth61 when posts are cemented with a resin cement than with other cements.53 Others.51 The cleaning and shaping procedures used in modern endodontic treatment are aggressive in the removal of dentin within the root canal space. long-term clinical results still are not available. removal of more dentin from the canal wall in the preparation of the post space should be kept to a minimum to preserve tooth substance and minimize root fracture. An increase in the post’s width. is becoming increasingly popular because of its potential to bond to dentin. which is contained in most root canal sealers. polycarboxylate. the post width should not exceed one-third of the root width at its narrowest dimension. First. and the risk of a root fracture remains a concern.39. thermocycling of resin cement used in thin film thickness probably is not as significant a problem compared with other restorative procedures. It is difficult and timeconsuming to remove a well-bonded resincemented metal post.R E S E A R C H the post. . The use of various types of fiber-reinforced posts and resin cement is becoming more popular. These cements also have a much lower modulus of elasticity than zinc phosphate and dentin. since fiberreinforced posts can be removed easily. resin-based composite and the hybrid of resin and ionomer cements—zinc phosphate has had the longest history of success. All rights reserved. removal of the demineralized collagen layer using a specific proteolytic agent such as sodium hypochlorite has been shown in an SEM study to improve the bonding of resin to the root canal wall owing to the penetration of resin tags into dentinal tubules along the wall.50 In general. studies have shown that there is no adverse effect on marginal seal60 and post retention62 when canals are obturated using an eugenol-containing sealer and a post is placed with a resin cement. Furthermore. and the modulus of elasticity of resin-based composite is similar to that of dentin. In the case of an endodontic failure. Vol. it is compatible with zinc oxide eugenol (ZOE). any residual gutta-percha and root canal sealer must be removed from the dentinal walls to ensure proper bonding of resin to dentin. In addition to having an extended working time. mechanical methods or both. and clinicians should bear in mind that most roots are not perfectly rounded. Microleakage is the major concern when using polycarboxylate and glass ionomer cements. especially in the apical area where the root surface usually becomes narrower and functional stresses are concentrated.63 Second.63-65 Another concern of using resin to cement a metal post is the difficulty in removing the post in case of endodontic failure. Some authors have expressed concerns regarding microleakage and thermocycling of resin cements. however. however. therefore.56 Finally. 136 www. Schwartz and Robbins66 offered a May 2005 615 JADA.ada. Among the most commonly used dental cements—zinc phosphate. on the other hand. a metal post that is cemented in the canal space with zinc phosphate is easier to remove and has a lower risk of root fracture compared with a metal post that is bonded strongly with a resin-based composite cement in the root canal space. will increase the risk of root fracture. A lentulo spiral can be used to carry acid etchant into the post space.55. while a fine-tipped microapplicator can be used to coat the canal walls with bonding agent. Thorough rinsing of the canal space can be achieved by using a three-in-one syringe and an irrigation syringe. retention and fracture strength of various post systems using continuous or intermittent loading with mixed results. glass ionomer cement. on the other hand. While it generally is believed that eugenol-containing root canal sealers can inhibit the polymerization of resin cements. removal of the smear layer through acid treatment and the wet bonding of dentin without contamination must be done carefully as with other restorative procedures using resin-based composite to achieve success. However.org/goto/jada Copyright ©2005 American Dental Association. Numerous in vitro and in vivo studies have been conducted to compare failure mode.11 A minimum of 1 mm of sound dentin should be maintained circumferentially.

82 Glass ionomer cement.70 resistance to leakage of oral fluids at the core-totooth interface. caused a 20 percent reduction of cuspal stiffness and mesial-occlusodistal cavity preparation caused a 63 percent reduction. Some of the negative features of resin-based composite are polymerization shrinkage. making it difficult to prepare immediately after placement if a crown is the final restoration.73 ability to bond to remaining tooth structure.71.77 minimal potential for water absorption78-80 and inhibition of dental caries. amalgam and cast gold as core material under a crown in ET teeth found no significant difference in fracture and failure characteristics among these materials. Placing amalgam can be challenging in badly brokendown teeth.68 Morgano and Brackett68 described some of the desirable features of a core material. Proper removal of the residual root canal sealer coupled with a small incremental buildup using a condensable resin-based composite material may help alleviate the potential of microleakage.10.71 dimensional stability. poor bonding characteristics to dentin and enamel. as they exhibit high strength and low solubility. which can result in 616 JADA. These negative features may lead to microleakage if they are not addressed properly during placement of the material. however. gold crowns. Placing an amalgam core requires a prolonged setting time. however. An occlusal cavity preparation. Resin-based composite offers an esthetically pleasing material especially in the anterior section under an all-porcelain restoration. These restorations can provide ET teeth with the desired protection. Reeh and colleagues84 compared the contributions of endodontic and restorative procedures to the loss of cuspal stiffness by using nondestructive occlusal loading on extracted intact human teeth. the use of glass ionomer cement as a core material should be avoided. regardless of whether there is scientific evidence to support the claim of toxicity. and all-porcelain restorations with cuspal coverage are used routinely as standard and acceptable methods to restore posterior ET teeth.83 Glass ionomer cement also exhibits a low modulus of elasticity.R E S E A R C H good summary of these studies in their review of post placement and restoration of ET teeth. They include adequate compressive strength to resist intraoral forces. Both gold and amalgam are not esthetically pleasing. They concluded that endodontic procedures do not weaken teeth www. One in vitro study comparing resin-based composite.72 ease of manipulation.69 sufficient flexural strength. hydroscopic expansion as a result of water adsorption and incorporation of voids in the buildup because it cannot be condensed like amalgam.67 and the buildup augments the development of retention and resistance provided by the remaining tooth structure. is an indirect procedure requiring two visits. and many patients are concerned about the presence of mercury in amalgam. Therefore. The most commonly used core materials are cast gold. I found mixed opinions as to whether full cuspal coverage should be carried out routinely on ET teeth. Placing cast gold post and core. was shown to be weak in tensile and compressive strengths. .ada. Furthermore. 136 resin that is not cured completely. They concluded that endodontic procedures reduced the relative stiffness by only 5 percent. especially under the newer all-porcelain restorations.74-76 thermal coefficient of expansion and contraction similar to tooth structure.org/goto/jada May 2005 Copyright ©2005 American Dental Association. Both cast gold and amalgam have been used successfully for many years. such an ideal core material does not exist. It has good strength characteristics and low solubility. provided a 2-mm ferrule existed on the margin of healthy tooth substance. ET anterior teeth with minimal loss of tooth structure may be restored conservatively with a bonded restoration in the access cavity. In my review of the literature. metal-ceramic crowns.12. All rights reserved. Vol. on the other hand. and their coefficient of thermal expansion is similar to that of tooth substance. and it had low fracture resistance as a core material in another study. Castings such as gold onlay.81 Unfortunately. poor condensability and high solubility. amalgam. they require extensive tooth preparation and can be expensive. as the commonly used materials all exhibit certain strengths and weaknesses. PRINCIPLES OF CORE BUILDUP The construction of a core buildup is necessary as the amount of residual tooth substance decreases. resin-based composite is incompatible with ZOE in many root canal sealers. resin-based composite and glass ionomer cement. on the other hand. THE FINAL RESTORATION As I stated earlier.69 biocompatibility.15 Neither a post nor a crown is required unless a great deal of natural tooth substance is lost as a result of caries or fracture.

occlusal principles. All rights reserved. an overdenture with good success. it probably is safer to provide some is necessary to make the right selection. leagues8 concluded that the greatest factor Other restorative options. fracture or both. Therefore. I reviewed the principles in the term clinical success. based composite coupled with acid and all-ceramic bridges also are if full cuspal coverage etching of enamel and dentin can available. restoration of teeth ture in ET teeth. The authors concluded that The number of endodontic procedures has cuspal coverage is important so as to minimize increased steadily in the past decade with highly the danger of marginal leakage and cuspal fracpredictable results. the Panitvisai and Messer87 studied the extent of patient can function with improved propriocepcuspal flexure after endodontic and restorative tion and better stability of the denture than with procedures and found that cuspal deflection a complete denture.7 Oliveira and colresult of caries. concluded that the clinical success dental material research has rates of ET premolars with limited focused on the development of It is necessary for loss of tooth structure restored with esthetic materials such as resindental practitioners fiber-reinforced posts and direct based composite with improved to evaluate each composite were equivalent to full bonding and the all-ceramic restocoverage with metal-ceramic rations. CastIf only a routine restoration is necessary.85 In a threedifferent types of all-ceramic crowns also have year clinical study. Restoring teeth with resincarefully to determine in service for a number of years. Unless the majority of natuse of posts and the various types of posts that ural tooth substance remains after endodontic are available. Mannocci and colleagues86 been fabricated with good results. it is necessary for dental practitioners to past several years. some basic concepts in evaluate each clinical situation carefully to deterrestoring ET teeth remain the same. May 2005 617 . fracture or structure. which conserves more tooth with a simple restoration.1 Although many new restoraIn view of the conflicting results of these tive materials have become available over the studies. and a sound knowledge observed a strong association between crown of the endodontic. mine if full cuspal coverage is required for longIn this article. restorative and placement and the survival of ET teeth. A thorough understanding of posts treatment.7. Vol. Porcelain crowns have been clinical situation crowns.org/goto/jada Copyright ©2005 American Dental Association. These researchers kind of cuspal coverage in the final coronal restoconfirmed in another study that it is the loss of ration since most teeth that require endodontic marginal ridges that was primarily responsible treatment usually are damaged severely as a for the change in stiffness. Recently. structure. 136 www. anatomy. resinings have been used for many years with good based composite with acid etching of enamel and success. porcelain onlay and dentin is the restoration of choice. An onlay. cuspal protection may be necessary for damaged by caries before endodontic treatment. periodontal.R E S E A R C H with intact marginal ridges. tered teeth. In a 10-year retrospective study after endodontic treatment is becoming an inteof ET teeth.ada. In the past decade. it long-term preservation of the remaining tooth may be sufficient to treat the endodontic access structure. When the influencing the strength of ET teeth (specifically marginal ridges are lost as a result of extensive premolars) was the amount of remaining tooth loss of tooth structure from caries. as there JADA. use of crowns on ET teeth may not endodontic treatment followed by a be necessary if the marginal ridges are intact and metal coping or magnet installation can support most of the natural tooth substance is preserved. or a crown can accomplish this. This way. Aquilino and Caplan88 found that ET gral part of the restorative practice in dentistry. is required for result in recovery of tooth stiffness When a tooth is needed to suplong-term clinical of up to 88 percent of that of unalport a removable prosthesis but it is success. If a tooth is not fractured or severely both.7 It can be concluded compromised periodontally or has from these studies that the routine an unfavorable crown-to-root ratio. increased with increasing cavity size in CONCLUSIONS mandibular molars. teeth that did not receive crowns after obturation Proper restoration of ET teeth begins with a good were lost six times more often than teeth that understanding of their physical and biomechanreceived crowns after obturation. and it was greatest after endodontic access. The authors ical properties.

29 Queen’s Road Central. Heydecke G. 29. In vitro comparison of intact endodontically treated teeth with and without endo-post reinforcement. 21. J Am Ceram Soc Discuss Notes 1977.51:780-4. J Dent Res 1989. . JADA 1987. Douglas WH. Finally. 18. Ichikawa Y. Ritter AV. AON China Building. Helfer AR. Hedlund SO. Corrosion behaviour of selected implant alloys (abstract 1177). J Prosthet Dent 2000. Trope M. da Silva L. Fracture resistance of endodontically prepared teeth using various restorative materials. Retention of prefabricated and individually cast root canal posts in vitro. J Prosthet Dent 1979. Cheung maintains a multispecialty private practice. Martinez-Insua A. Br Dent J 2003. Kane JJ. Dennison J. 23. Clinical procedure for luting 618 JADA. Resistance to fracture of endodontically treated teeth restored with different post systems. Rilo B. 8. Clinicians must keep this fact in mind when selecting these materials.84:180-4. Although many promising new materials are available and there are definite indications for their use. Riis DN. Vol. I have concluded that posts do not strengthen ET teeth and should not be used in them routinely. Guzy GE. 30. An in vitro study of the fracture resistance and the incidence of vertical root fracture of pulpless teeth restored with six post-and-core systems. Stiffness of endodonticallytreated teeth related to restoration technique.68:322-6. Rolf KC. Site comparisons of dentine collagen cross-links from extracted human teeth. and conventional post systems at various stages of restoration. Robert Ng and Miss Vivian Wong for their kind assistance in the literature search and the manuscript preparation. Burns DR. Johansson NG. Sorensen SE. s Dr. Suite 503. Morgano SM. J Prosthet Dent 1996. Johnson RR. and each has its advantages and disadvantages. However. Baraban DJ. Grandini S. The main function of a post is for the retention of a core if there is insufficient tooth substance left to support the coronal final restoration. Schilder H. Melnick S. retention. Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. Sjögren G. Carter JM. Tissue compatibility and stability of a new zirconia ceramic in vivo. Comparison of the fracture resistances of pulpless teeth restored with a cast post and core or carbon-fiber post with a composite core. but clinical evaluation is necessary over a longer term. Sirimai S. Rafter M. Pelleu GB. Hochstedler J. Pontius O.633-53. Resistance to fracture of restored endodontically treated teeth. Int J Prosthodont 1997. Dent Asia 2004. 16. J Dent 2001. Endodontically treated teeth as abutments. Cementation of posts with resin cement seems to offer better retention. Sjögren U. Sorensen JA. Baratieri LN. Modification of the resistance form of amalgam coronal-radicular restorations. Properties of and important concepts in restoring the endodontically treated teeth. respectively. The restoration of pulpless teeth. Tronstad L. Address reprint requests to Dr. the choice of core material and the final restoration are important in achieving long-term clinical success. Boyer DB.89:360-7. J Prosthet Dent 1984. Hong Kong SAR. Strub JR. Sorensen JA. Determination of the moisture content of vital and pulpless teeth. 9. Cormier CJ. 32. All rights reserved. 13. J Prosthet Dent 1984. Intracoronal reinforcement and coronal coverage: a study of endodontically treated teeth. long-term clinical evaluations are needed.6:347-74.53:631-6. The reason that many different types of posts with different designs and materials are available is because they all have certain strengths and weaknesses. 19. However. J Prosthet Dent 1998. 12.28:710-5.42:39-44. 22. 6.71:253. Sokol DJ. Ferrari M. De Andrada MA. Effective use of current core and post concepts. Gold. Arch Oral Biol 1993. Reeh ES. Yaman P. Morgano SM.195:155-8.87:431-7. The author wishes to thank Dr. cementing a post with resin cement must be performed meticulously. Oral Surg Oral Med Oral Pathol 1972. 27. Goretti A. Yamauchi M. Rivera EM.81: 262-9.Sept. Dr. Akagawa Y. J Biomech 1983.16:841-8.68:1540-4. Fracture resistance of endodontically treated teeth restored with composite posts. 1. 15. amalgam and resin-based composite are acceptable core materials.61:10-5. Oper Dent 1992. 28. Stress analysis of five prefabricated endodontic dowel designs: a photoelastic study. Denehy GE. biocompatibility. Heuer AH. 4. Parker MW. 17.13:26-9. Martinoff JT. Levine MS. esthetics and retrievability.10:498-507. In vitro comparison of fracture resistance and failure mode of fiber. Porcelain-fused-to-metal post and core: an esthetic alternative.ada. J Prosthodont 2001. Poillion C. China. Mechanism of toughening partially stabilized zirconia ceramics (PSZ). J Biomed Mater Res 1972. the use of glass ionomer cement as a core material should be avoided. J Prosthet Dent 1989. low stiffness. Klawitter JJ. J Prosthet Dent 1991. Burgess JO. Cheung W.:40-7 2. Restoration of pulpless teeth: application of traditional principles in present and future contexts. Akkayan B.115:57-60. Dietschi D. Post space preparation requires good understanding and knowledge of tooth anatomy to avoid unnecessary mishaps. As a result of this review. Billy E. Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite.1:108-11. Messer HH. Bergman B.29:427-33. Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement. Monaghan P. Porter DL. Oliveira FdC. Tissue reaction to three ceramics of porous and non-porous structure. Adaptation of adhesive posts and cores to dentin after fatigue testing. 24. Endod Dent Traumatol 1985. poor bonding characteristics and high solubility. Arcari GM. Santana U. Restorative and endodontic results after treatment with cast posts and cores.38:541-6.80:527-32. Selection criteria should include adequate strength. Dent Clin North Am 1967. Maltz DO.10:26-36.org/goto/jada May 2005 Copyright ©2005 American Dental Association. as this procedure is technique-sensitive. Martinoff JT.17:86-92.75:375-80. J Prosthet Dent 1985. Sundquist G. Nikai H. 25. Cheung. 26. J Prosthet Dent 1992. 7. 3. ceramic. J Prosthet Dent 1999. 11. 10. Newman MP. Morrison SJ. Teitelbaum RL. 14.34:661-70. J Endod 2002. Tsuru H. Huband M.60(3-4):183-4. Hutter JW. The new fiber-reinforced posts offer impressive results. 136 www. William Cheung & Associates. Kim J. Roh L. Gülmez T. less microleakage and higher resistance to tooth fracture.65: 470-4. 31. Lundquist P.52:231-4. 20. J Prosthet Dent 2003. J Prosthet Dent 2002. Punch shear testing of extracted vital and endodontically treated teeth. J Dent Res 1992./Oct. Vichi A. Hulbert SF. Butz F. Romelli M. J Dent Technol 1996. modulus of elasticity. 5. Nicholls JI.R E S E A R C H are so many choices available. owing to its low strength. Moon P.

74:385-91. Garcia-Godoy F. Rábade LB. Dent Clin North Am 1976.24:703-8. JADA. Davidson CL. 88. 57.15:512-6. Standlee JP. In: Cohen S. Goldsmith LJ. 76. 87. Gardiner DM. when and how. Retention of endodontic dowels: effects of cement. Mannocci F. An evaluation of post length within the elastic limits of dentin. The resin-bonded cast post core: technical preparation and cementation protocols. 85. In vitro fatigue behavior of restorative composites and glass ionomers. Nissan J. Cook WD. J Mich Dent Assoc 1982. 64. Larson TD.85:284-91. Foundation restorations in fixed prosthodontics: current knowledge and future needs. Sherriff M. J Prosthet Dent 2002. In vitro study of endodontic post cementation protocols that use resin cements. Post retention: the effect of sequence of post-space preparation. Walker WA. Robbins JW. Chicago: Quintessence. Braem MJ. 33.57:554-9. Mannocci F.127:1397-8. Kvist T. Meiers JC. Endod Pract 2002. J Endod 2004. Caputo AA.R E S E A R C H glass-fiber posts. Harcourt JK. Mannocci F. Svare CW. J Prosthet Dent 2003. Ho J. 60. Rosen H. Part I. Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: a confocal microscopic study. J Prosthet Dent 1995. Am J Dent 2000. Braem MJ. J Endod 1989.68:584-90.11(5):973-86. Microleakage of composite resin cores treated with various dentin bonding systems. Dimensional stability of silver amalgam and composite used as core materials. Clinical evaluation of fiberreinforced epoxy resin posts and cast post and cores. Vichi A. Efficacy of different adhesive techniques on bonding to root canal walls: an SEM investigation. J Prosthet Dent 1991.19:183-8. Post preparations: a comparison of three systems. Hirschfeld Z. 55. Kotsanos N. Brackett SE. J Prosthet Dent 1992. 46. Caughman WF. Retention between a serrated steel dowel and different core materials. Pathways of the pulp. Gladys S. J Prosthet Dent 1987. Nathanson D. Cuspal deflection in molars in relation to endodontic and restorative procedures. In vitro shear strength of bonded amalgam cores with and without pins. Dental adhesion and the All-Bond system.September:29-39.88:297-301. Dionysopoulos P. Watson TF. Jacobi R. 10th ed. Dent Mater 1995. Schwartz RS. Assif D.89:146-53. DiFiore PM.11:137-41. 61. Pilo R. Burns RC. 65. Microleakage of pin-retained amalgam and composite resin bases. 33:397-400. Endodontic dowel retention with resinous cements. Shillingburg HT. J Prosthet Dent 1973. 51. Caputo AA. When to use fillers. Denehy GE.13(special issue):15B-18B.77:843-5. JADA 1996.68:913-7.20:299-311. Pashley DH. 40. J Prosthet Dent 1978. J Endod 1989. Koliniotou-Koubia E. J Prosthet Dent 2002. 44. Postendodontic restoration. 36.13(special issue):9B-13B. Quintessence Int 2003. Millstein PL.17:422-9. Standlee JP.21:57-61. 59. Jensen JR. J Prosthet Dent 1997.org/goto/jada Copyright ©2005 American Dental Association.65: 480-2. Kovarik RE. Ferrari M. Kao EC.52:489-91. Am J Dent 2000. Burns DR. Aust Dent J 1993. 4th ed. J Endod 1998.34:301-6. J Biomed Mat Res 1994. Effect of endodontic sealers on dowels luted with resin cement. Lombardero PR. Mezzomo E. Vichi A. Messer HH. Miller DA. Mason PN. The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth. Stern N. 3rd ed. Nathanson D. Vanherle G. J Endod 1995. Gettleman L. Dmitry Y. Ward ML. A ‘one-bottle’ adhesive system for bonding a fibre post into a root canal: an SEM evaluation of the post-resin interface. St Louis: Mosby.29:125-31. dowel length. The effect of post adaptation in the root canal on retention of posts cemented with various cements. diameter. Caplan DJ. 58. Ferrari M. 54. Lo CS. Johnston WM. Lambrechts P. J Prosthet Dent 1992. Caputo AA. Watson TF. Vichi A. St Louis: Mosby. Eissmann HF. Purton DG. Ferrari M. Kazemi RB. J Prosthet Dent 1991. J Prosthet Dent 2001. Ferrari M. and different sealers.88:302-6. Colt SG. Mannocci F. J Endod 2003. 41. Rydin E.9:233-41. Messer HH. Effect of root canal sealers and irrigation agents on retention of preformed posts luted with a resin cement. Average maximum post lengths in endodontically treated teeth. Fracture toughness of water-aged resin composite restorative materials.82:643-57. 84. Grandini S. Douglas WH. Construction of detached core crowns for pulpless teeth in only two sittings. 75. 52. 66. J Esthet Dent 1991. Dunn JR. Millstein PL. Sarkar NK. 63. Fatigue life of three core materials under simulated chewing conditions.14:372-81. Christensen GJ. Hart S. 79. Ferrari M. 1997:194-204. 136 www.87:256-63.3:353-9. Hormati AA. Hanson EC. Post placement and restoration of endodontically treated teeth: a literature review. 38. Bachicha WS. Oliva RA.28:1397-402. 69. Pamenius M. Grant BE. Fracture resistance of four core materials with incorporated pins.77:17-22.30: 289-301.80:151-7.44:526-30. J Prosthet Dent 1964. Murchison DF. 37. Harcourt JK. In: Biomechanics in clinical dentistry. Burns DA. Fracture resistance of teeth restored with two different post-and-core designs cemented with two different cements: an in vitro study. Bahillo JD. 73. Tjan AH. eds. Levin E. Lautenschlager EP. The use of reinforced composite resin cement as compensation for reduced post length. J Prosthet Dent 2002. 49. Breeding LC. Zillich RM. 77. 78. 43. JADA 1968. Morgano SM. J Prosthet Dent 1987. J Prosthet Dent 1980.44:40-4. Operative procedures on mutilated endodontically treated teeth. Standlee JP. Donald HL. Effect of core stiffness on the in vitro fracture of crowned. Astback J. 56. Relationship between crown placement and the survival of endodontically treated teeth. Gordon FL.9: 137-41. Pract Periodontics Aesthet Dent 1997. Indrani DJ. 74.34:199-201. Ferrari M.38:39-45. Craig RG. Fundamentals of fixed prosthodontics. 67. Televantos F. Pins and posts: why. The reinforcement of weakened pulpless teeth. cementation time. Mason PN. Corcoran JF. and design.ada. 82. Int J Prosthodont 1989. 45. Reeh ES. A retrospective study of 236 patients with teeth restored by carbon fiber-reinforced epoxy resin posts. Reduction in tooth stiffness as a result of endodontic and restorative procedures. Hobo S. Retrospective study of the clinical performance of fiber posts. Restoration of endodontically involved teeth. Boone KJ.66:24-9. 53. 47. Radke RA Jr.57:277-81. Brackett SE. J Prosthet Dent 1998. Effect of fatigue testing on core integrity and post microleakage of teeth restored with different post systems. Int Endod J 2000. 50. J Prosthet Dent 1980. Standlee JP. Assif D. Cardash HS. Brockhurst PJ.2:569-78. Varela SG. Chicago: Quintessence. Fredriksson M. endodontically treated teeth.3:129-32. eds. 42.15:578-80. 72. All rights reserved. Leary JM. J Adhes Dent 2001. Qualtrough AJ. Libera SD. Microleakage of endodontically treated teeth restored with posts. J Endod 2001. Reit C. 48. Arvidson K. Threeyear clinical comparison of survival of endodontically treated teeth restored with either full cast coverage or with direct composite restoration. Dent Mater 2001. Lowe JA.27:768-71. J Endod 2000. 83. Kanca J 3rd. Lambrechts P.64:303. Caputo AA. In vitro flexural fatigue limits of dental composites. Massa F. J Prosthet Dent 2001. Park SA. Sixto JM.30:162-5. Scianamblo M. J Prosthet Dent 1961. Restorative dental materials.67:458-67. 39. Reid LC. J Prosthodont 2000. J Prosthet Dent 1992. Webster NP. Tyas MJ. Bartlett SO. Influence of dentinal adhesives and a prefabricated post on fracture resistance of silver amalgam cores.39:400-5. Principles of preparing endodontic treated teeth for dowel and core restorations. Chan FW. 1987:640-3.11:201-7. Restorations and endodontic success: the correlationship of post-endodontic restorations and endodontic success: rationale and materials. Moon PC. Papagodiannis Y. Bertelli E. Quintessence Int 2003. A comparison of the retention of tooth-colored posts. Gutmann JL. Jeansonne BG. Oper Dent 1994. Dent Mater 1995. Vanherle G. 80. Chandler NP. Silverstein WH. Microleakage of composite resin and amalgam core material under complete cast crowns. 70. Mayhew JT. 71. 81. 68. The relative frequency of periapical lesions in teeth with root canal–retained posts. build-ups or posts and cores. Secondary caries formation in vitro around fluoride-releasing restorations. Aquilino SA. May 2005 619 . 1987:185-203. Whitsett LD. 34. J Prosthet Dent 1984.86:304-8. Vol. J Prosthet Dent 1999. 62. 86. Vichi A. 35. Aquilino SA. Windchy AM. 1997:137.26:341-4. Panitvisai P. Schindler WG. Ford TR.

Sign up to vote on this title
UsefulNot useful