Post and Core

What, Why, when and How ?

What:
Post: →part accurately fits the prepared root canal.

Core: →part outside pulp chamber which rebuilds

the loss part of the coronal tooth.

Extra-coronal restoration: → it is that part

restoring both esthetic and function of tooth.
Indications

•1. crowns for badly destructed endodontically treated anterior and posterior teeth.
•2. Retainer for short span bridge. → when the abutment is endodontically treated.
•3. When tooth can't be restored by any type of restoration as in:
• i) ↑ bilateral proximal caries with pulp exposure
• ii) Fractured teeth with pulp exposure
• iii) Endodontically trated teeth with ↑ coronal destruction
•4. Endodontically treated teeth with biologically sound root ( no resorption / no fracture)
•5. Endodontically treated teeth with perfect seal.
•6. endodontically treated teeth with long / thick / strong root
•7. Endodontically treated teeth without any periapical pathosis.
•8. Endodontically treated teeth with healthy P.D and alveolar support.
Contra Indications
•1. Improper R.C filling → must be corrected first.
•2. Presence of peri-apical pathosis → surgical treatment should be done
•3. Weak / thin / curved / very narrow root.
•4. Heavy / edge to edge bite.
•5. Patient with diseased P.D support → P.D treatment should be done.
•6. Patient with bad habits e.g → nail biting→ clenching.
Classifications
1-According to material:
All metallic
•Metallic post
•amalgam core
•metal crown
Non metallic
• Fiber re-inforced composite post Glass fiber PostCarbon fiber

•The modulus of elasticity are Similar to dentin  better Stress distribution i.e cushion effect

•Zirconia post and core

Combination
e.g metal post with non metallic esthetic veneer
•e.g metal post with composite or re-inforced glass.ionomer Core
Classifications
2-According to method of fabrication:
A-Ready made (prefabricated)
• Supplied in different sizes / shapes → available with special drills.
• ↓ rotational resistance because of their cylindrical shape. →therefore auxiliary pins are inserted to prevent
rotation.  
• The coronal part of the post contains retention mechanism for the core-materials (amalgam / composite /
reinforced G..I)
• ▪ Adv. → simplicity of the technique .
Classification of Ready made post
According to post design
• Parallel sided post ↑ Retention ↓conservative
• Tapered post ↑ conservatism
• Parallel with tapered end
According to post surface configuration:
• Smooth posts ↓ retention
• Serrated posts more retentive
• Threaded posts high retentive
According to material:
•Metallic e.g Ni-Cr/Ti/St-st
•non metallic eg e.g carbon fiber post /glass fiber post / zirconia post
Classifications
2-According to method of fabrication:

B-Custom made post

Casted from → NiCr / CoCr / Au type IV/Titanium/Zirconia

Indicated in →i) > 50% destruction

• →ii) Non circular canal
• → iii)Extremely tapered canal
• 
 If there is 50 % of the remaining tooth structure but with coronal undercut  ready made post may be
recommended in order to preserve the tooth structure and achieve strong bond.
Classifications
2-According to method of fabrication:

B-Custom made post

Adv. → ↑ strength than prefabricated post
• → ↑ fit than prefabricated post
•▪The apical end of cast metal post can be thinned to a minimum of 0.8 mm.

N.B:
•In case of wide anterior canal  ready made fiber re-inforced composite post can be used and cemented with resin cement fitting
to the apical part of the canal  then customized by adding fiber re-inforced composite auxillaries to fill the cervical part. ( ever
stick technique) 
•In the same issue we can customize the prefabricated zirconium post by press on technique using the empress system.
When
1)Metal post :
Used in presence of thick periodontium and low lip line → as grayness caused by metallic post inside
root has an impact on the final esthetic results
•Adv: → Strong and durable
• → Only one appointment is required for the fabrication of the restoration.
•Disadv:
•→ Stiffness of the post may cause root fracture.
• Gray shadow may appear if used in thin gingiva
•i.e less esthetic
• Corrosion
N.B :
•In general rigid post ( metal and zirconia) must be fitting to the four wall of the canal in order not to
concentrate the stresses root fracture
When
2)Carbon fiber post and composite core:
Used in presence of thick periodontium and low lip line → as grayness caused by metallic post inside
root has an impact on the final esthetic results
•Adv:→ Only one appointment is required for the
• fabrication of the Restoration.
•  Carbon fiber post can bond to tooth structure
•  Modulus of elasticity similar to dentin 
• Cushion effects decreasing stresses along
• Post dentin interface
• Ease or retrievability
•Disadv→ The black color decrease the esthetic
•  presence of carbon may lead to corrosion effect
•  rotational forces may cause post fracture
When
3)Zirconium post and composite core (cosmo-post)
•▪used in presence of thin periodontium and high lip line in teeth with no
discoloration or that have been bleached
•Adv: ==> Natural root color
•Disadv: No long term data are available on the Clinical performance of this
material
• Stiffness of the post can cause root fracture.
•  Bonding failure may occur
When
4)Glass fiber post and composite core:
used in presence of thin periodontium and high lip line in teeth with no discoloration or that have
been bleached
•Disadvantage  weak against rotational ( torsional) forces may lead to its fracture
•Adv:  Natural root color
•  Modulus of elasticity similar to dentin  Cushion effects decreasing stresses along
• Post dentin interface
•  Excellent bond to tooth structure
• Ease or retrievability

•It appears that glass Fiber re-inforced posts, in combination with adhesive bonding, resin cement
and composite core material, may have the possibility to act like a homogeneous unit ( Monoblock)
as they have the same modulus of elasticity , if successful bonding is achieved.
When
Factors affecting treatment plan
For anterior teeth;
•If intact / no discoloration /not used as abutment for F.P.D therefore →composite filling in the access
cavity
•If intact / discoloration therefore according to the degree of discoloration the following treatment
option can be done:
•i)Minimal discoloration→ bleaching +composite
•ii)Moderate discoloration →bleaching +laminate veneer
•iii)Extensive discoloration → crown +post and core
For posterior teeth;
•-Mainly posterior teeth is subjected to greater occlusal forces → therefore need post and core + crown
•-However in mandibular first molar with intact marginal ridges and conservative access cavity i.e less
destruction →Cuspal protection can be indicated only without post i.e Endocrown
Why
:Weakness of the endodontically treated tooth •
1-Dehydration of dentin : which will result in ↓ strength and toughness 14 % as the
vital content of the pulp is removed
2-Caries destruction → loss of large part of tooth structure → weakness
3-During access cavity preparation→ removal of the pulp chamber roof which is
resistant to stress and pressure→ weakening to the tooth
4-During mechanical preparation → we remove large portion of dentin of the root
canal →weakening of tooth structure
5-Esthetic change→
• i)Biomechanical alteration of dentin light refraction that affects its appearance
•ii)medication and root canal sealer → discoloration
How
pretreatment Evaluation:

Pretreatment evaluation:
•The quality of the existing endo ttt should be evaluated:
•a)If well treated → proceed in the treatment
•b)If over filling or under filling (1.5-2mm) and the tooth is asymptomatic → proceed in the treatment
•c)If over or under filling and tooth is symptomatic → retreatment
•d)If peripaical radiolucency → retreatment
•e)No pain on percussion / no fistula / no exudates/ no acute inflammation.

Periodontal evaluation:
•The margin of the restoration should be placed on sound tooth structure, therefore in case of subgingival extension of caries or no sound tooth
structure→
•i)Gingivectomy
•ii)Crown lengthening
•iii)Orthodontic extrusion
Restorative evaluation:
•The remaining tooth structure should be evaluated
•Abnormal habits or heavy occlusal forces may affect type of restoration.
Esthetic evaluation:
•In case of thin gingival margin / high lip line→ selection of esthetic glass fiber post or zirconia pos
How
Principles of tooth preparation to receive post crown:

I) Conservation of tooth structure:

a) Preparation of the root canal: 
•Minimal root canal enlargement → to remove the undercuts and enable the post to fit accurately →otherwise ↓
dentin thickness → weaken the root → fracture. 
•Most roots are narrower mesio-distally than facio-lingually Therefore post must not be more than ⅓ the
diameter of the root. ( minimum 1mm of dentin should exist around post at cervical area)
a) Coronal preparation: 
•▪ Maintain the coronal tooth structure as much as possible because → ↓ stress concentration at gingival margin.
•▪ If ↑ coronal tooth loss → extension of preparation 2mm apical to the missing tooth structure→ Ferrule effect
→ with bind the remaining tooth structure + prevent root fracture during function.
How
Principles of tooth preparation to receive post crown:

II) Retention form:

A-post geometry.
•▪Parallel side post are ↑ retentive than tapered.
•▪ In severely tapered root canal → parallel sided post may weaken the root.
B-Post design:
•▪ Smooth (least retention)
•▪ Serrated (more retention)
•▪ Threaded (most retention) → It must be inserted carefully → to avoid root fracture.
•
How
Principles of tooth preparation to receive post crown:

II) Retention form:

C- Post length:
•▪ ↑ post length → ↑ retention but Too long post may lead to:
i) damage of seal of root canal filling.(bec of hydraulic pressure of excess cement)
ii) Root perforation if apical ⅓ of the canal is curved.

Length of the post should be:

•→⅔ of the root length.
•→ leave 3-5 mm root canal filling intact
•→ at least equal to the coronal portion (1:1 ratio)
• 
D-Post diameter:
•▪ ↑ Post diameter → ↑ retention. but post must not be more than ⅓ the root diameter → otherwise weaking the root→ fracture.
•▪ 1mm thickness of dentin should remain around the post at midroot and cervical area.
• 
E-Luting agents:
•▪ The choice of luting agent → have little effect on post retention.
•▪However, adhesive resin cement is indicated if post have ↓ retention.
•but no cement can completely compensate for short comings of retention and resistance form.
How
Principles of tooth preparation to receive post crown:

III) Resistance form:

a) Stress distribution:
•Post and core should distribute the forces over large area as much as possible.
•Effect of post design on stress distribution:
i) ↑ post length → ↓ stresses.
ii) During function → greatest stress concentration at cervical / apical part.(Therefore dentin should be conserved in these area if
possible).
iii) ║ sided post distribute force better than tapered post which may have wedging effect but║ sided post → ↑ stress at apex.
iv) The use of ║sided posts with tapered end.
iv) Avoid any sharp angles → otherwise stress concentration.
v) Threaded post or unvented ║ sided post →↑ stress during insertion Therefore flexi-post ↓ stress during insertion
How
Principles of tooth preparation to receive post crown:

b) Rotational resistance:
•To prevent rotation of post with circular cross section:
i) If ↑ coronal tooth structure remains → rotation is prevented by vertical coronal wall.
ii) If ↑ coronal tooth structure loss → rotation is prevented by groove in canal wall at cervical bulkiest side
(lingual aspect)
iii) Auxillary pin in the root face. However screwed pins is not recommended because it induce cracks
• ( cemented pins are more preferred)
Ferrule effect:
• the extension of crown margin to be 2mm apical to the junction between core and tooth structure→ therefore binding more tooth structure together→ better
distribution of force → prevent root fracture.
• 
•• In extensively damaged tooth → ferrule effect is created by:
•Orthodontic extrusion crown lengthening
• ↓ ↓
• Preferred Not preferred bec it
• affect C/R ratio
 The orthodontic extrusion is preferred than crown lengthening because it will not decrease the root length related to the coronal portion + it preserve
the esthetic of the gingival zenith  however it may be accompanied by soft tissue management
• ( gingivectomy)
 Ferrule is mandatory in labial and palatal surface (not less than 1.5-2mm) because of high forces directed in labio-palatal direction
•while
•ferrule can be limited proximally to 0.5 mm due to ↓ force exerted.
•N.B:
•In cases where is no sufficient ferrule  we can rely on the collar effect by beveling the root face buccally
and lingually  making the crown margin at a more cervical position than tooth/core junction.
•However the prognosis is less than the ferrule effect.
Post crown for multirooted teeth:

•Because no papalism between the prepared canals→ common path of insertion for cast metal post and core might be
impossible.
•Therefore we use:
1) The strongest and widest R.C→ distal in lower molar. → palatal in upper molar.
• To gain more retention + avoid perforation of the thin canal
1) Ready made post in different root canals then building the core either by amalgam / composite / G.I.
• However during posts insertion we might face a problem as the head of one post may interfere the insertion of the other
• To overcome this we should use different length post to make one post head to be more higher than the others , however
the lowest level head will not give sufficient retention for the core.
•3)Widest root canal with part of the other root canal which is parallel to it. ( in case of custom made post)
•4) Using interlocking custom made post and core → the interlock should be ║ to the direction of the other post.
Procedures of tooth preparation to receive post crown:

 
I) Removal of indodontic filling material: 
•removing gutta-percha.
a) With warmed endodontic plugger → after obturation (same visit)
b) With rotary instrument →Gates glidden drill
• →peeso- reamers.
• → special drills.
a) Rotary instrument + chemical agent as chloroform. 
II)Preparation of root canal: 
a) For custom-made posts:
•• It is used for →non- circular canal or → extreme taper
•Therefore slight widening of the cervical ⅔ of the canal → otherwise weaken the root.
b) For ready made post:
•• The canal is enlarged and shaped with special drills→ that match the shape and configuration of the post. i.e →the canal is diverged in case of
• tapered post
• → the canal is made with ║ walls
• In case of ║sided post
Procedures of tooth preparation to receive post crown:

•III)Preparation of coronal tooth structure:

1) prepare the remaining tooth as it was not damaged.
2) Remove any caries or undermined tooth structure but be careful to preserve tooth structure as much as possible.
3) In cast post & core → coronal prep. Should be ║ to post insertion.
4) The root face should be prepared to have 2 inclined planes → labial
→ lingual
•In order to →↓ crown displacement
• →↓ destructive load applied to the root.
1) Providing the anti-rotational element (groove)
2) Eliminate the sharp angles + establishing smooth F.L.