Restorative Dentistry

Biomechanical criteria for evaluating

prefabricated post-and-core systems:
A guide for the restorative dentist
Charles T. Smith, DDS*/NotTnan J. Schuman, DDS*^¡^AValetha Wassoti, DDS***

Selecting the optimum prefabricated post-and-core system can be a complex and imprecise exercise for the
restorative dentist. First, no single prefabricated post-and-core system fits all situations. Second, the vast
number of post-and-core components currently on the market complicates the selection process. Finally,
useful biomechamcal criteria for evaluating prefabricated post-and-core components are difficult to quantify.
The prefubriciited poit-and core system consists of three components: the post, a core material, anda luting
cement. Each combination of component types is a potential system alternative. This article presents useful
biomechanicat criteria, based on current restorative guidelines, for evaluating the basic components of any
prefabricated post-and-core system. (Quintessence Int I998;29;3O5-3I2)

Key nords: biornechanicjl criteria, posl-and-oore system, prefabricated post

Mouton published his design of a gold crown with a

Clinical relevance
Biomechanical criteria for evaluating prefabricated
system components will enable the restorative den-
tist to (¡) make an informed choice among the
many components currently available and (2) struc-
ture components already on hand to create alterna-
tive systems.
he use of prefabricated posts and plastic filling
T materials to fabricate post-and-core systems was
introduced in the 1960s.' However, post-and-core sys-
tems have been in use in dentistry for more than 250
years.- In 1728, Pierre Fauchard described the use of
"tenons," which were metal posts screwed into the roots
of teeth to retain his prostheses.' In 1746. Claude
" Associate Professor, Department of ProsthtidoiMics, Division of Fixed
Prosthodontics, University of Tennessee, Memphis, Coilege of Den-
tistiy, Memphis, Tennessee.
»'Associate Professor, Deparlment of Biologic and Diagnostic
Sciences, tjniversity of Tennessee, Memphis, College of Dentislry,
Memphis, Tennessee.
*•" Associate Professor. Departmeni of General Dentistry, tJniversity of
Tennessee. Memphis, College of Dentistry, Memphis. Tennessee.
Reprinl requests: Dr Charleü T Smith, University of Tennessee,
Memphis, Coilcge of Dentistry, 875 Union Avenue. Memphis, Tennessee
J8163.E-mail:CSmiIh@dentai.utTnem.edu
gold post that was to be inserted into the root canal.^
Use of the ""pivot crown,"' a wooden post fitted to an
artificial crown and to the canal of the root, was com-
mon practice during the mid-1800s.- Also during this
period, the "Richmond crown." a post-retained crown
with a porcelain facing, was developed to function as a
bridge ret ai n er.-
After severai decades of use, one-piece post crowns
were eventualiy replaced by the cast post and core,
made as a separate entity from the crown. This two-step
technique provided improved marginal adaptation and
did not limit the path of insertion for the crown solely to
the long axis of the tooth. In addition, an unserviceable
restoration could be replaced without having to remove
the post,-"
Studies show that restored, endodonticaliy treated
teeth that receive timely, definitive, restorative treat-
ment have significantly greater longevity than do nonre-
stored teeth.'' " It is also well documented that minimal-
ly damaged endodonticaliy treated teeth may be
restored conservaliveiy and do not require a post and
core or a crown.•^"-'- However, most teeth selected for
endodontic treatment have already sustained some
degree of coronal damage from trauma, caries, and/or
prior restorative procedures.^'' The added loss of tooth
structure from endodontic procedures, followed by
reduction for a crown preparation, usually leaves insuf-
ficient support for a crown.'-* Typically, a core founda-

Quintessence International 305


(Core mate ri a i s)
A /*
• w~' • ^ ~~
Glass- Resin Amaigam
ionomer composite
F i g 1 Alternative prefabricated post-and-core systems utiiizing materials avaiiabie in 1997.
Potential aiternatives = (A x B x C): potentiai aiternatives = ( 3 x 4 x 6 ) ; total = 72.
tion made of plastic filling materials is used to replace
this lost tooth structure and provide support for the
crown. However, when there is not enough sound tooth
structure remaining to provide retention for a core, a
post and core is needed.
When a post and core is required, the restorative den-
tist may choose a custom-cast post-and-core system or a
prefabricated po.st-and-core system. With the custom-
cast post-and-core system, a post is customized to fit the
cana], and both post and core are ca,st as a single unit.
With the prefabricated post-and-core system, the canal
is enlarged to fit the configuration of the selected post,
and the core is made by adding a plastic filling material.
Custom-cast posts are indicated in teeth with ellipti-
cal or excessively Hared canals, while prefabricated
posts function best in teeth with small circular canals.^
The custom post and core is almost always more con-
servative of remaining tooth structure, prompting
Morgaño'-' to recommend its use whenever a post-and-
core system is indicated. However, the prefabricated
post-and-core requires fewer appointments and is a less
complex procedure. According to Shillingburg et al,"
the prefabricated post-and-core system is the tnost
widely used system.
306
/^ G lass-ionomer
/^ Poiycarboxyiate
/• Zinc phosphate (Luting cements)
Resin-based B
• Parailei, threaded
• Parallel, smooth-sided
• Parallel, serrated (Prefabricated posts)
• Tapered, threaded ^
' Tapered, smooth-sided
' Tapered, serrated
The objective of a post-and-core system is to pro-
vide the retention for a crown that would normally be
gained from sound coronal tooth structure.-* •' The noted
systems analyst, Thomas H- Athey,'-* defines a system
as any set of components working together for the
overall objective of the whole. Narrowly defined, the
prefabricated post-and-core system consists of just two
components: a metal post and a core of plastic filling
material. However, the system's objective cannot be
met without a lufing cement to enhance retention and
to aid in creating a seal along the canal. Posts, regard-
less of shape and surface configuration, are inserted
with a luting cement. Therefore, a prefabricated post-
and-core system consists of three components; (1) pre-
fabricated post, (2) plastic core material, and (3) luting
cement.
By considering the various forms or types each
component could take, all available potential system
designs or alternatives are developed.'•• There are six
classes of posts, three classes of plastic filling materi-
als, and four classes of luting agents (cements) com-
monly used for prefabricated post-and-core compo-
nents.''•"•'^ Therefore, each combination of component
types is a potential system alternative (Fig 1).
Voiume 29, Number 5,
 Obviously, few restorative dentists would find it
practical to have on hand every conceivable system
component. The challenge for the restorative dentist is
to select the most appropriate components to meet the
overall system objective. The restorative dentist must be
able to make an informed choice from among the many
components currently available and to structure compo-
nents already on hand to create alternative systems.
Selecting the optimum prefabricated post-and-core
system can be a complex and imprecise exercise for the
restorative dentist. First, no single prefabricated post-
and-core system fits every situation. Second, the vast
number of post-and-core components currently on the
market (many supported only by in vitro laboratory
results without direct clinical correlation) cotnplicates
the selection process. Third, and most important, useful,
specific biomechanical criteria for evaluating prefabri-
cated post-and-core components are not readily avail-
able to the restorative dentist.
Biomechanical criteria tailored to the overall system
objectives are essential if the restorative dentist is to
make a successful choice among components and, ulti- Fig 2 The post iength (PL) should be equal to the anatomic
crown (AC), or two thirds the iength of the root, with 4 to 5 mm of
mately, system designs. This article presents biome- apical gutta-percha seai (AS) remaining.
chanical criteria, based on current prosthodontic and
restorative guidelines, for evaluating the basic compo-
nents of any prefabricated post-and-core system.

Biomechanica) criteria to geometry (shape and configuration) or by the method

According to Anusavice,'^ the selection of dental materi-
als for clinical use is based on (1) biocompatibiiity. (2)
physicochemical properties, (3) handling characteristics,
(4) esthetics, and (5) economy. However, only biocom-
patibiiity, physicochemical properties, and handling
characteristics are directly related to success or failure of
the prefabricated post-and-core systems."" For brevity
and clarity, these three areas are grouped into the single
overall category of biomechanics. A review of post-and-
core systems was conducted to deteiinine objectives and
optimum standards for each component. The selected
biomechanical criteria are specific aspects of the compo-
nent objectives. This approach ensured that criteria
selected would be based on sound restorative principles
and tailored to the overall system objectives.
Prefabricated posts
The primary objective of every post is to provide reten-
tion for the core,' Post retention is influenced by the
canal contour; post size, shape, and surface configura-
tion; and the luting agenfii'-^^ (Fig 2). The shape and
surface configuration of the post have a pivotal effect on
retetition."'' Prefabricated posts are classified accorditig
of retention.'"''(see Fig 1).
Posts thai are retained primarily by surface threads
that mechanically engage the dentin are considered
active, while those that do not contact the canal wall
but rely on cement for retention are considered passive.*
Active, or threaded, posts are more retentive than the
passive-fitting posts, and parallel-sided posts are more
retentive than tapered posts. Standlee et al," in their
definitive study on post retention, demonstrated that (1)
parallel-sided, threaded posts are more retentive than
parallel-sided, serrated posts, and (2) that parallel-sided
posts are more retentive than tapered, smooth posts.
Because active posts depend on tlireads that engage
the dentin, they create more stress during installation and
loading than do other designs." Pretapping post chan-
nels, limiting the number of post threads, and "backing
off' one tum, are some of the techniques used to reduce
stress with active posts. The tapered self-threading post
creates the greatest stress of all existing post designs.*
Passive tapered posts are self-vetiting and create little
stress during installation. However, tapered posts,
whether active or passive, have high potential for wedg-
ing during loading.'"'"' In contrast, the parallel-sided,
serrated post with a vent distributes stress more evenly
than any other design.^""

Quintessence international 307

 strength Corrosion resistance Retention
1 Cobalt-ohromium 1. Titanium
2 Sta in i es s sleel 1. Active parallel-Elded
2. H ig h-platinum 2. Aotive tapered
3 Titanium 3. Coba it-chromium
4. High-piatinum 3. Passive parailei-sided
4. Stainless steei 4. Passive lapered
5 Brass 5. Brass

Prefabricated
posts

Stress Safety Conservation

distnbuticn
1. Passive tapered 1 Passive tapered
1. Passive paral i el-sided 2 Passive pa ral i ei-sided
2. Passive parailei-sided
S. Passive tapered
3. Aclive pa ral i el-sided 3. Aclive tapered
3. Active parallel-sided
4. Active tapered 4. Active parailei-sided
4. Active tapered

Fig 3 Application of selected biomechanical entena to evaiuste prefabricated posts.

Post selection is guided by both external root contour
and the shape of the prepared canal,** The more closely
the post selected fits the canal (in size and shape), the
less likely the potential for canal preparation that results
in perforation of the root.''-^ Tapered posts conform well
to end odontic ally prepared canals and are more conserv-
ative of tooth structure,^
Conventional prefabricated posts are made of stain-
less steel, titanium and its alloys, platinum-gold-palla-
dium, chromium-containing alloys, and brass.•'•'
Recently introduced nonmetallic posts, especially the
carhon fiber-epoxy post, show promise,--^-'' However,
metal posts are proven over time and continue to domi-
nate the market.
Post stiffness (modulus of elasticity) and post corro-
sion are major considerations in the selection of metal
posts,•'•^•"•-'' Titanium alloys are the most corrosion resis-
tant. However, titanium's strength is much less than that
of either cobalt-chromium-molybdenum or stainless
steel,* Both stainless steel and brass exhibit low corro-
sion resistance,'' Platinum-gold-palladium, titanium, and
cobalt-molybdenum incorporate the best combination
of strength and corrosion resistance,•'•^•''•^ According to
Jacobi and Shillingburg,'^ brass is the least desirable
alloy because of its low strength and low corrosion re-
sistance. Also, nickel-containing alloys should he
avoided in nickel-sensitive patients,''
In summary, the optimum prefabricated post is made
of bigh strengtb, corrosion-resistant materiai, possesses
good retentive and stress distribution characteristics,
and is capable of being installed with minimal risk of
either perforation and/or loss of tooth structure,-"-^ 8,17-23,27
Consequently, the criteria for prefabricated posts are (})
strength, (2) corrosion resistance, (3) retention, (4)
stress distribution, (5) safety, and (6) conservation of
tooth structure (Fig 3).

308 Voiume 29, Number 5

Core mute rials
The core provides retention and resistance form for the
final restoration, Amalgatn, resin cornposite, and glass-
ionomer are u,sed to bnild cores for prefahricated post-
and-core systems,'*' Atnalgam is relatively easy to man-
ipulate and has high compressive strength and low
tnicroleakage characteristics. Amalgam is also suffi-
ciently abrasion resistant to ,serve as an interim restora-
tion if the casting is delayed. However, its .setting titne
and lack of adhesion to tooth structure are disad-
vantages,-'''" Although fast-setting amalgam (high-cop-
per amalgam) exhibits sufficient compressive strength to
allow preparation within I hotir of placement, tensile
strength is low. regardless of copper content,-" Relatively
thin cores of amalgam are highly susceptible to fracture.-''
Reports on the efficacy of dentin bonding agents used
with amalgam are varied. In two recent clinical studies,
Mahler et•àVreported no difference in bond strengths of
bonded and unbonded amalgam, while Belcher and
Stewart-"' evaluated restorations for retention and found
an amalgam adhesive to be clinically effective, Donald et
al,^- in a laboratory study, concluded that the use of adhe-
sive honding with amalgam cores increases resistance to
amalgam fracture.
Amalgam bonding systems are improving; however,
they are not currently equal to composite honding
systems,-'' Resin composite (including reinforced com-
posite) has adequate strength, honding capahilities, and
rapid setting,-^-'"' '•• However, a tendency for microieak-
age and low dimensional stahility are its disadvantage.s,-"^
Glass-ionomer (including silver-reinforced glass-
ionomer) exhibits true adhesion to tooth structure, fluo-
ride release, and low thermal coefficient of thermal
expansion. However, its inherent lack of strength and
hrittleness are significant disadvantages,-! " ' - " Recently
introduced resin-reinforced glass-ionomer restorative
materials are easy to place, set on command, and resist
early moisture contamination; however, they are weaker
than resin composite and exhibit inadequate strength for
load-bearing simations.^*""
In summary, the optimum prefabricated core material
is an easily placed, rapid-setting, high-strength, dimen-
sionally .stable material with minimum marginal leakage
and an effective bonding mechanism/-^""" The corre-
sponding criteria for core materials are (!) ease of use,
(2> setting time, ¡3) strength, (4) dimensional stahility,
(5) microleakage, and (6) honding mechanism (Fig 4),
Luting cemetits
Posts are cemented into canals to enhance retention and
to aid in creating a seal along the canal,-" Also, it has
Quintessence Internalional
been reported that the cernent layer provides a buffer
zotie that contributes to uniform stress distribution
between the post and canal wall,^" According to Cohen
et al," normal occlusal forces create micromovement
of a cemented post, resulting in disintegration of the
cement and the concentration of stress at the apical end
of the root overtime.
Zinc phosphate, glass-ionomer, polycarboxylate, and
resin-based cements (resin composite, unfilled resin, and
dentin bonding agents) are the more commonly utihzed
post luting cements. Zinc phosphate cement exhihits
high cotnpressive strength, adequate film thickness, and
ease of use,"^"* However, high ,solubility and inability to
bond to tooth structure are distinct disadvantages,''^**
Glass-ionomer cement exhihits adhesion to enamel
and dentin, equals zinc phosphate in retention, and is
cariosiatic,^''-" However, susceptibility to moisture con-
tamination during setting is a distinct disadvantage,'^
The recently introduced resin-reinforced glass-ionomer
cement is growing in popularity. However, its useful-
ness as a post cement is yet to he determined becaase it
has not been documented,''™ Polycarboxylate bonds
chemically to tooth structure and stainless steel but
not to gold,'''^ Its low compressive strength, high vis-
cosity and soluhility, and shorter working time are
disadvantages,-'"
Resin composite cement can be bonded to dentin by
use of dentin bonding agents and to enamel through
acid-etching teehniques. Resin composite cements, or
adhesive resins, that incorporate the phosphonate,
hydroxyethyl methacrylate, or 4-methacryloxyethyl
trimellitate anhydride adhesion systems are stronger
than conventional cements,''*" Studies have shown
that removal of the smear layer and the use of unfilled
resin produces a more retentive hond than zinc phos-
phate cement,-"- Additionally, resin-hased cements are
virtually insoluble in oral fiuids'''; however, excessive
film thickness and lack of uniform manipulation tech-
niques are problem areas,-"-"
Microleakage is an important consideration in eval-
uating luting cements"" and restorative success,''''
Microleakage beneath crowns has been indicated as a
cause of endodontic failure.™^' However, the role of
luting cement in preventing mieroieakage along the
post canal is not well documented, Fogel-'- studied the
microleakage of posts luted with {1} zinc phosphate
cement, (2) polycarhoxylate cement, (i) resin compos-
ite, and (4) dentin bonding agents and found none
capable of achieving a fluid-tight seal.
Although a leak-proof luting agent has not heen
demonstrated, the relative resistance of various luting
agents to microleakage should be considered. Accord-
ing to McLean,""^ glass-ionotner cemetits exhibit better
309
Smith et al

Ease of use Setting time Strength!

1. Resin composite 1. Resin composite 1. Amalgam

2. Giass-ioriomer 2. Resin composite
3. Giass-lonomer 3. Amalgam 3. Glass-ionomer

^ ^ ~.

Core materials

Dimensions i Bonding
Micro îakage mechanism
stability
1. Amalgam 1. Resin composite
I.Amalgam
2. Glass-ionomer 2. Giass-ionomei
3, Resin composite 3. Resin composite 3. Amalgam

Fig 4 Appiioation of seiected biomeohanicai criteria to evaluate core materiais for prefabri-
cated post-and-core systems.

long-term resistance to microleakage than do dentin Conclusion

bonding agents. However, an in vitro microleakage
study of luting agents found resin-based cement ¡adhe-
sive cement) to be the most resistant to microleakage
followed hy glass-ionomer, zinc phosphate, and polycar-
hoxylate cements." Tjan et al-" reported that resin com-
posite cores {retained hy a prefahricated post cemented
with a resin composite) treated with various honding
systems exhihited significantly reduced microleakage.
In summary, the optimum cement for a prefahricated
post exhibits high strength, low fiim thickness, low solu-
bility, adequate honding ability, ease of manipulation, and
provides a marginal seai that prevents microleak-
£[gg 5,6.40-53 Therefore, the criteria for luting ceinents are
(1) strength, (2i film thickness, (3) solubihty. (4) bonding
mechanism. (5) ease of use, and (6) microleakage (Fig 5).
An evaluation of system components is necessary before
an informed decision can he made on which system to
implement. The relative impoitance of the biomechani-
cal criteria to individual clinicians will vary. However,
the criteria are applicable to any prefabricated post-and-
core system and are essential to an informed .selection.
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310 Volume 29, Number 5

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2 Zinc phospiiate 2. Poiycarboxyiate 2, G lass-ionomer
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Voiume 29, Number 5. 1993