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Clinical Conservation: by mohammed ali

Treatment planning

• In general, post is indicated when there is a little or no coronal
tooth structure after endodontic treatment.

• When there is a lot of remaining coronal structure, placing a post
become arguable, some some dentists prefer placing post even if the
coronal structure is preserved, to prevent cervical fracture.

• Placing post and core system should be done on successful
endodonticlly treated tooth.

• The position of the reamer should be centered in the root canal
filling material to avoid perforation.

Pretreatment Evaluation:

• 1- Quality of the endodontic treatment:

• The endodontic treatment should be properly done.

• Retreatment should be considered if tooth exhibits any clinical
signs of inflammation, a periapical pathology exists, or inappropriate
endodontic filling material was used ( silver pointes).

• 2- Periodontal condition:

• This is important for long-term success of teeth.

• Weak teeth should be extracted.

• A mutilated tooth in which the restorative treatment would
violate the junctional epithelium or the attachment level (e.g.
extensive caries, perforations, external root resorption) should be
considered for crown- lengthening surgery or orthodontic extrusion.

3 Careful handling of the tissues. stresses are greatest at the facial and lingual surfaces of the root and an internal post. . and crown system is indicated. when more extensive protective and retentive features are required in the restoration: 1 Bruxism and heavy occlusion. Many function with composite resin .4.The amount of remaining coronal tooth structure: More than half à conservative treatment with coronal restorations without posts. 2 Abutment teeth for long-span fixed bridges. Considerations for anterior teeth Anterior teeth do not always need complete coverage. premolars. core. and often 1 st molar) requires: 2 Careful selection of restorative materials. 5. The functional load on the tooth: The post.restorations when the tooth is loaded. except when plastic restorative materials would have limited prognosis in view of the extent of coronal destruction. core. 4 Timely endodontic intervention to prevent darkening of the root as it looses vitality. and definitive restoration.Esthetic zone (Anterior teeth. 3 Abutment teeth for free end removable partial denture. minimalà post.

combined with their morphologic characteristics.being only minimally stressed. because complete coverage gives the best protection against fracture Post Length Since 5 mm of gutta-percha should be retained apically to ensure a good seal (as measured radiographically).remaining tooth structure ?WHAT IS THE PROPER LENGTH FOR A POST A wide range of recommendations have been made :regarding post length. posts should be extended to that length in all teeth except .molars With molars. does not help prevent fracture considerations for posterior teeth Endodontically treated posterior teeth are subject to greater loading than anterior teeth are because of their position closer to the insertion of the masticatory muscles. especially maxillary premolars. Extension beyond this length can lead to root perforation or only very thin areas of . This. . which includes the following . posts should be placed in the primary roots (palatal root of maxillary molars and distal roots of mandibular molars) and should not be extended more than 7 mm apical to the origin of the root canal in the base of the pulp chamber.makes them more susceptible to fracture Complete coverage is recommended on teeth with a high risk of fracture.

they endanger the root specially weakened one.The post should be four-fifths the root length (6) The post should be terminated halfway between the (7) . are associated with a high number of vertical root fractures The diameter of the post should be kept to a minimum.The post should be one and one-third the crown length (3) . The post length should equal the incisocervical or (1) .crestal bone and root apex :Short posts lead to greater stress at the coronal aspect of the canal and are more susceptible to dislodgement or root fracture.The post should be longer than the crown (2) .occlusocervical dimension of the crown .The post should be half the root length (4) . consistent with the rigidity . Very short posts. • Tapered posts are most conservatives but they have inferior retention and stress distribution properties. those ending in the cervical third of the canal.The post should be two-thirds the root length (5) . parallel posts are less conservative at apical part and case stress concentration at this area. but when they are made of extremely rigid materials such zirconia. It is also essential to maintain the integrity of the endodontic obliteration • Custom made posts considered more conservative that ready- made post.required and the width of the endodontic obliteration Preservation of natural root structure will maintain maximum tooth strength. parallel side with tapered end posts considered the best design .

Coronal preparation -maintain the coronal tooth structure as much as possible -only caries and undermined enamel should be removed Preparation should be started with smaller reamer size available and gradually sized up The position of the reamer should be centered in the root canal filling material to avoid perforation The Ferrule placed on a tooth with optimal ferrule. root or post fracture or post . Where inadequate ferrule exists. Radicular preparation -minimal root canal enlargement -over enlargement can weaken the root b.• The new customized ready-made fiber posts like (everstick) have the conservative and adaptive advantages of custom posts and the favored stresses of fiber posts preparation- a. occlusal stresses are transferred directly to the core and/or post with high likelihood of tooth. A minimum sound dentine height of 1. the crown and root function as one It is a 360 degree circumferential ring of sound tooth structure that is enveloped by the cervical portion of the crown restoration. dislodgement due to the effect of the tapered post . structure When a crown is integrated unit and occlusal forces are transmitted in normal physiological fashion to the periodontium.5-2 mm apically to the junction between the core and the remaining part of the tooth .

In such cases adequate circumferential tooth structure :can best be gained by . 2.of the biological width The orthodontic extrusion in case of no sound tooth structure is accessible is the preferred procedure more than the surgical lengthening that affect the crown – root .improve the pognesis . ratio : So the ferrule to be formed it should be 1. Decrease risk of fracture without ferrule. Binds the tooth structure together Consequences of Inadequate Ferrule ◆ Catastrophic root fracture ◆ Cement failure and post loosening ◆ Post fracture .. The ferrule must not be less than 1. Antirotation effect. Minimum of 1. 2.5mm Importance of ferrule 1.5 -2 mm in labial and palatal surfaces because of high forces directed in the . Completely encircle the tooth .a) Forced orthodontic eruption . 3. Have parallel walls .5 – 2 mm in height. b) Surgical crown lengthening c) sub-gingival preparation and prolonged temporization( in selected cases ) to allow reestablishment . labio-palatle direction while it can be limited to 0.

specimens were restored according to four build-up approaches (n = 10 per group): (a) NF–NP (no ferrule. no post) and (d) F–P (ferrule. and subsequently endodontically treated. (b) (b) NF–P (no ferrule. fibre post) . fibrepost). After 24-h water storage at 37 8C. no post).Effect of ferrule and post placement on fracture resistance of endodontically treated teeth after fatigue loading (j o u r n a l o f d e n t i s t r y 4 1 ( 2 0 1 3 ) 2 0 7 – 2 1 5( Objectives: To evaluate the influence of the ferrule effect (1) and the fibre-post placement (2) on the fracture resistance of endodontically treated teeth subjected to cyclic fatigue loading Methods: 40 extracted single-rooted upper pre-molars were sectioned at the CEJ (groups a and b) or 2 mm above the CEJ (groups c and d). (c) (c) F–NP (ferrule.

200.000 cycle under water irrigation using a chewing simulator with sliding movement (Willytech. All specimens that survived fatigue loading were fractured using a universal loading device (Micro-Tester. Germany). A sinusoidal load of 0–50 N was applied with a stainless-steel ball-shaped stylus in the centre of the occlusal area of the crown.RelyX Posts (3M-ESPE) were used in groups NF–P and F–P. Instron) Results .0 (Kuraray). Load was applied at 458 at a frequency of 1.000 cycles using a chewing simulator (Willytech). A standardized composite core was built. after which specimens were restored with an all-ceramic crown (IPS Empress CAD. and were cemented with Panavia F 2. simulating 5 years of clinical function. Ivoclar-Vivadent) Fatigue loading Specimens were embedded in methacrylate resin at 2 mm from the CEJ to simulate the bone level and submitted to a fatigue load of 1.6 Hz.200. Failures under fatigue loading were recorded during testing by means of integrated LVDT displacement-sensors Specimens were fatigued by exposure to 1.

000 fatigue cycles Overall. Analysis of failures showed a prevalence of repairable failures in all groups. the ferrule effect has been found to significantly affect the fracture resistance of endodontically treated teeth Placing a post into the root canal has not been found to be less beneficial to increase the fracture resistance of endodonticallyt reated teeth by Besides. All the other specimens survived the 1. although a higher number of notr epairable failures were observed in groups NF–NP and F–P (Retention loss of the core in NF–NP during fatigue loading was considered as repairable failure .200.Fatigue loading Only one NF–NP specimen failed during fatigue loading because of loss of core retention.

a post may eventually improve retention of the restoration.Conclusions It can be concluded that: Endodontically treated teeth with a circumferential ferruleof 2 mm height and restored without a post may survive fatigue loading as well as teeth restored with a fibre post. Avoiding extra-removal of sound tooth structure rather than using a fibre posts does protect endodontically treated teeth against catastrophic failures. in teeth where a ferrule is not preserved. However. .

other between the cement and the core material Monoblock is to function successfully as a mechanically homogenous unit. Monoblocks are those that have two circumferential interfaces. the . it is achieved by adhesion modulus of elastisity coefficient of thermal expansion The combined use of a core material and a cement/sealer in contemporary endodontic obturations and fiber post adhesion introduces additional interfaces into a monoblock. since only endodontically treated teeth with a 2 mm ferrule and restored without fibre posts did not show not-repairable root fractures Inserting a fibre post seems not to be necessary to improve the fracture resistance of endodontically treated teeth in which a ferrule is preserved. whereas is effective in teeth without any ferrule What monoblock It is the ability of every component of tooth and restorative material to act as one unit. as well as . the materials that constitute a monoblock should have the ability to bond strongly and mutually to one another. one between the cement and dentin. First.

(its elastic modulus was close to that of dentin and its stress concentrations in dentin were low). posts cemented with zinc phosphate cements often failed because of the cement’s relatively . With the increase of the moduli of elasticity of the different cements . On the contrary. high stress concentrations were found in the root dentin ( stress 24.3 GPa was used that was similar to the modulus of elasticity of dentin.8 GPa) and a glass ionomer cement (elastic modulus 4. a heavily filled resin cement with an elastic modulus 18.5 MPa to 20.to the substrate with which the monoblock is intended to reinforce. the stress concentrations in the root dentin decreased from 24. When Panavia F .5 MPa and 23. This is because some of the stresses were redistributed to the cement layer . Second. respectively). these materials should have moduli of elasticity that are similar to the substrate.6 MPa.employed Although zinc phosphate cement demonstrated push out strengths comparable with other resin cements for the cementation of titanium or fiber posts . These stresses were directly transferred to the root dentin as the stress concentrations within .8 MPa. the respective stress concentrations in the root dentin were lower (20.8 MPa).0 GPa) were used for cementation. when Superbond C&B cement (elastic modulus 1. the cement layers were low Important conclusions could be derived with respect to the interaction between dentin adhesion and elastic moduli of the materials .9 MPa and 20.

the lower modulus of elasticity of glass ionomer cements also explains why they are less efficient than dentin adhesives and composites in strengthening immature roots and roots bonded with . fragility and low bonding potential to the root . have the potential to . theoretically. oxygen inhibition layer- free methacrylate resin matrices that. having a modulus of elasticity very similar to the modulus of elasticity of dentin.great elastic modulus. bond to methacrylate-based resin cements . quartz-coated carbon fiber posts The first implied existence of a mechanically homogeneous monoblock in the root canal space was reported with the bonding of . dentin and the post surfaces This explains why roots reinforced with posts that were cemented with dentin adhesives are more fracture resistant than those cemented . epoxy resin-based. carbon fiber-reinforced posts to root dentin The carbon-fiber posts. with zinc phosphate cements Likewise. This should help to distribute masticatory loads homogeneously and reduce . can achieve a tooth-post-core monoblock instead of an assembly of heterogeneous materials.stresses during function The epoxy resin embedding matrix in older generations of fiber posts is also replaced with highly cross-linked.

This is probably due to the similarity in the . Although the use of these newer generations of fiber posts has not yet attained the scientific rigor of an ideal monoblock.moduli of elasticity between fiber posts and root dentin -: Ideal monoblock resin cement + resin fiber post + Resin Core Material and crown .Different modalities of surface treatments of posts are also available to render these newer generations of fiber posts more conducive to bonding to methacrylate-based resins.