Post and core

1.Introduction

! The completion of root canal treatment does not signal the

end of patient management. The endodontically treated
tooth has to be restored to both form and function.
 What are effects of endodontic
treatment on the tooth?

Structural changes
➢ Tooth weakening caused by:
• Caries;
• Trauma;
• Access cavity preparation;
• Radicular preparation;
➢ Compromised structural integrity.
 What are effects of endodontic
treatment on the tooth?

Changes in dentin:
➢ A reduced amount of moisture in non-vital teeth.

Aesthetic considerations:
➢ Loss of tooth structure;
➢ Change in appearance because of alteration in biochemical
properties of dentin;
 2. Definition

➢ A postand core is a restoration consisting of

a post that fills a prepared root canal and a
core inserted into the pulp chamber that
establishes the proper coronal tooth
preparation.
 2. Definition

➢ Post: This is a metal or other rigid

restorative material placed in the
radicular portion of a non vital tooth. A post is fitted into a prepared
canal of a natural tooth. When combined with an artificial crown or
core, it provides retention and resistance for the restoration.
➢ Core: Refers to properly shaped substructure, which replaces missing
coronal structure and retains the final restoration. The core is designed
to resemble or become the crown preparation or crown itself.
 3. Purpose of the post

➢ The purpose of the post is to provide retention for the core.

 4. Indications

➢ Significant loss of hard dental tissues

➢ Successful endodontic treatment (Optimal apical seal)

➢ Absence of active inflammation

➢ No sensitivity to percussion

➢ Absence of associated periodontal disease

➢ Sufficient bone support around the root.

 4. Indications

➢ Good periodontal health

➢ Suitable root canal

➢ Good crown to root ratio

 5. Contraindications

➢ Severe curvature of the root

➢ Dilacerations of the root

➢ Persistent periapical lesion

➢ Poor periodontal health

➢ Poor crown to root ratio

 5. Contraindications

➢ Weak / fragile roots

➢ Bad endodontic treatment

➢ Enough sound dental tissues

➢ Economic factors
 6. History

➢ In 1728, Pierre Fauchard described the use of “TENONS” which

were metal posts screwed into the roots of teeth to retain the
prosthesis.
➢ 1745 – Claude Mouton published his design of a gold crown
with a gold post that was to be inserted into the root.
➢ 1830-1870 –Wood replaced metal as the material of choice for
posts.
➢ 1839 Harris proposed that gold and platinum were superior to
brass, silver and copper which tended to corrode.
 6. History

➢ G.V. Black 1869 developed porcelain fused to metal crown held in by a screw
inserted into a canal filled with gold foil.

➢ “Pivot crown” – a wooden post fitted to an artificial crown and to root canal.

➢ In 1966 prefabricated posts and composite resin cores came into use.

➢ In1990 Duret et al. described a non-metallic material for the fabrication of

posts based on the carbon-fiber reinforcement principle
 7. Requirments

➢ Provide maximum protection of the root to resist root fractures.

➢ Provide maximum retention of the core and crown.
➢ Be easy to place.
➢ Be less technique sensitive.
➢ Have high strength and fatigue resistance.
➢ Be visible radiographically.
➢ Be biocompatible.
 7. Requirments

➢ Physical properties compatible to core.

➢ Maximum retention with minimum removal of dentin.
➢ Even distribution of functional stresses along root surfaces.
➢ Esthetic compatibility.
➢ Minimal stress during placement and cementation.
➢ Resistance to displacement.
➢ Easy retrievability.
➢ Reasonable cost.
➢ Post should have modulus of elasticity similar to the dentin.
7. Requirments

Modulus of elasticity of different kind of posts

7. Requirments

Distribution of functional stresses along root surfaces of:

- natural tooth
- tooth, restored with fiber post
- tooth, restored with metal post
 8. Main parts of the post

➢ Radicular part - The radicular part is placed in the root canal

of the tooth. It can have different shape : cylindrical, conical,
combined or torpedoed shape.
➢ Coronal part – The aim of the coronal part is to provide
retention of the restorative material. It can have cylindrical or
prismatic shape.
 9. Classification of the radicular posts

➢ According to fit.
➢ According to shape.
➢ According to the way of manufacturing.
➢ According to the material.
➢ According to light transmission.
➢ According to esthetic results.
 А. According to fit

➢ Passive – Passive posts are passively placed in close contact to the dentin
walls, and their retention primarily relies on the luting cement, used for
cementation. The diameter of the root canal is slightly bigger than the
diameter of the post.
➢ Active (screw posts) – Active posts derive their primary retention directly from
the root dentin by the use of threads. Most active posts are threaded and are
intended to be screwed into the walls of the root canal.
➢ Flexi posts.
➢ They are all cemented.
Active posts Flexi post

Passive posts
 B. According to the shape

➢ Cylindrical shape
➢ Conical shape
➢ Combined shape
➢ Torpedoed shape
 C. According to the way of manufacture

➢ Prefabricated;
➢ Custom made: direct and indirect method;
• Indirect method – with silicone impression.
• Direct method – Use of soft, flexible and unpolymerised glass
fiber post which can be individually adapted to the shape of
the root canal.
https://www.youtube.com/watch?v=2XXawpezx5U
D. According to the material

➢ Metallic:
• Titanium; ➢ Non-metallic:
• Stainless steel; • Non-esthetic:
• Brass; – Carbon fiber post;
• Esthetic:
– Glass fiber;
– Quartz;
– Ceramic;
D. According to the material

Metallic posts Non-metallic posts

 D. Fiber posts

➢ The fiber posts consist of reinforcing fibers (carbon, glass or quartz)

embedded in a resin polymerized matrix. There are some fiber posts that
consist of combination of fibers - for example carbon and glass. The fiber
content can vary from 35 to 65 percent.
➢ The carbon fiber posts are black and non-transparent. They have modulus of
elasticity, that is similar to the modulus of elasticity of the dentine. Тhey are
stronger in comparison to the other fiber posts. They are easily retrievable.
 D. Fiber posts

➢ The glass fiber posts are white. They are transparent or non-transparent. They
also have modulus of elasticity similar to the modulus of elasticity of the
dentine. The transparent ones are light transmitting.
➢ The quartz fiber post are white, transparent or non-transparent, but they are
stronger than the glass fiber posts.
D. Fiber posts

Quartz fiber posts

Carbon fiber posts

Different shapes of fiber posts

Glass fiber posts

 D. Different fiber post systems

Fibers posts from different systems differ mainly in:

➢ Rigidity;
➢ Diameter of the posts;
➢ Type of the fibers;
➢ Fiber/matrix ratio;
➢ Way of cementing in the root canal;
➢ Shape;
 D. Different fiber post systems

Luscent Anchors

Twin Luscent Anchor

TOKUPOST
 D. According to the material

Metal Posts Fiber posts

High corrosion potential, which can lead to discoloration Good physical qualities
of the hard dental tissues
Non-adhesive bonding to the root canal Adhesive bonding to the root canal

Non-esthetic Biocompatibility

Higher modulus of elasticity than the dentine Mechanical qualities and modulus of elasticity,
that are similar to the dentine

Can cause allergic reactions Great esthetic results are possible

 D. According to the material

Metal Posts Fiber posts

Can cause vertical fractures of the root Adhesive bonding of the coronal restoration with the
post

They are not subject of corrosion

They have high resistance

 E. According to light transmission

➢ Light transmitting.

➢ Non-Light transmitting.
 E. According to the aesthetic result

➢ Non-esthetic – metal.

➢ Esthetic – zirconia posts and fiber posts.

 10. Factors to be considered
while planning post and core

➢ Retention and the resistance form.

➢ Preservation of tooth structure.
➢ Ferrule effect.
➢ Mode of failure.
➢ Retrievability.
 A. Retention and the resistance form

➢ Postretention refers to the ability of post to resist vertical

dislodging forces. Post resistance refers to the ability of the
post and the tooth to withstand the lateral and rotational
forces.
 A. Retention and the resistance form

Factors affecting post retention:

➢ Post length.
➢ Post diameter.
➢ Post taper and design.
➢ Luting agent.
➢ Luting method.
➢ Canal shape.
 A. Retention and the resistance form

Factors affecting post resistance

➢ Post length.
➢ Rigidity.
➢ Presence of antirotational features.
➢ Presence of ferrule.
 A. Retention and the resistance form

Post Length:
➢ Accepted guidelines for determining post length include:
• Post should be equal to clinical crown length.
• Post should end halfway between the crestal bone and the root apex.
• Post should be as long as possible without disturbing the apical seal.
Post Diameter
➢ It has been seen that post diameter has little difference in the retention
of post, but increase in post diameter increases the resistance form but
it also increases the risk of root fracture.
 A. Retention and the resistance form

Post Design
➢ Different types of post designs available are:
• Tapered, smooth sided.
• Tapered, serrated type.
• Parallel smooth sided.
• Parallel serrated type.
➢ Generally parallel sided are more retentive than tapered ones.
 A. Retention and the resistance form

Luting Agents
➢ Commonly used dental
cements for luting the posts
are:
• zinc phosphate;
• polycarboxylate;
• glass ionomer cement;
• resin-based composite;
 A. Retention and the resistance form

Luting Method
➢ Luting method also affects the retention of post. Since luting agents are
susceptible to moisture present in the canal so canal should be absolute dry.
 B. Preservation of tooth structure

➢ One should try to preserve maximum of the coronal and

radicular tooth structure whenever possible.
 C. Ferrule Effect

➢ Ferrule is encircling collar of metal band

or ring used to fit the root or crown of a
tooth. Basically, it braces the tooth and
protects it against the wedging stresses
and vertical root fracture.
 D. Mode of Failure

➢ All post systems show some percentage of failure but with variable
range.
➢ Failures of posts and core can occur in form of:
• Post fracture;
• Root fracture;
• Core fracture;
• Post dislodgement;
 E. Retrievability

➢ Ideally a post system selected should be such that if an endodontic

treatment fails, or failure of post and core occurs, it should be
retrievable.
 11.Root selection in case of multirooted teeth

➢ Root canal in the zone of largest destruction.

➢ Straight massive root canals with great dentine thickness.

➢ Root canals with good apical seal and no periapical lesions.

12. Instruments for preparing the root canal

Pesso reamer Callibration drills

 13. Basic methods for preparing the root canal and cementing the post

➢ For passive metal post.

➢ For active metal post.
➢ Custom cast metal post and core.
➢ For aesthetic fiber post.
A. Passive metal post

➢ Analysis of the x-ray.

➢ Post selection.
➢ Isolation.
➢ Remove the gutta-percha filling. (4-5 mm of gutta-percha should be left).
➢ Prepare the canal space using Gates-Glidden drills or Pesso reamers.
➢ Rinsing and drying of the canal.
➢ Application of the cement and the post.
A.Passive metal post
 B.Active post

➢ Analysis of the x-ray image and post selection.

➢ Isolation.
➢ Removal of gutta-percha.
➢ Preparing of the canal with drills.
➢ Rinsing and drying the canal.
➢ Application of the cement and active screwing of the post with screw key.
B. Instruments for active post
B.Active post
B.Active post
 C. Custom cast metal post and core

➢ First clinical stage:

• Selection of plastic post;
• Removal of the part of the gutta-percha filling
• Preparing of the root canal with drill, compatible with the plastic post;
• Adjusting of the plastic post;
• Silicone impression;
https://www.youtube.com/watch?v=rGORIbotSGo
 C.Custom cast metal post and core

➢ Lab stage - preparing of the custom cast metal post and

core;

➢ Second clinical stage – Adjusting and cementing.

 D.Esthetic fiber post

➢ Analysis of the x-ray image.

➢ Isolation with rubber dam.
➢ Removal of gutta-percha (4-5mm should be left).
➢ Use of pilot drill and calibration drill from the set.
➢ Rinsing and drying the root canal and cleaning the post with alcohol.
➢ Use of self-adhesive duo-composite cement. After the application of the
cement in the root canal, the post is placed and it’s light cured for 40 s.
 D.Esthetic fiber post

https://www.youtube.com/watch?v=f96v_pCDZEQ
https://www.youtube.com/watch?v=treNt3zRrNQ
https://www.youtube.com/watch?v=TQSdGuVBA0w
D. Esthetic fiber post
D. Esthetic fiber post
 14.Various Core Build-up Materials Available

➢ Dental amalgam.
➢ Resin modified glass ionomers.
➢ Composite resin.
➢ Reinforced glass ionomers cement.
 15.Ideal Requirements for a Core Material

➢ Biocompatibility. ➢ No reaction with chemicals.

➢ Ease of manipulation. ➢ Low cost.
➢ Ability to bond to tooth structure ➢ Easily available.
and post.
➢ Coefficient of thermal expansion
similar to dentin.
➢ Minimal water absorption.
➢ Dimensionally stable.