1

PROSTHODONTIC MANAGEMENT OF
ENDODONTICALLY TREATED TEETH

DR.S.ANUMITHA
II YR PG
DEPARTMENT OF
PROSTHODONTICS
INTRODUCTION
❑ An endodontically treated tooth can resume full function and serve
satisfactorily as an abutment for a fixed or removable partial denture.

❑ However, special techniques are needed to restore such a tooth.

❑ The loss of tooth structure makes retention of subsequent restorations

more problematic and increases the likelihood of fracture during
functional loading
HISTORY
In 1700 Fauchard inserted wooden dowels in canals of teeth to aid
in crown retention
The wood would expand in the moist environment to enhance
retention of the dowel

In 1869, Black favored the use of metal posts in which a

porcelain-faced crown

was secured by a screw passing into a gold-lined root canal.

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HISTORY

mid-1800s •Clark developed a device which was extremely practical for its time because it included a tube that allowed drainage from the apical area or the canal

1878 •Richmond crown was introduced it incorporated a threaded tube in the canal with a screw retained crown

1958 •Hampson EL etal and Demas NC et al; modified to eliminate the threaded tube and was redesigned as a 1-piece dowel and crown

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❑ 1930 •During the, the custom cast post and core was developed to replace the one piece post crowns, because of their drawback of using in diverging roots and difficulty in
removal and replacement of FPD crowns

1960 • prefabricated posts were introduced.

1990 •Duret et al described a non metallic material for the fabrication of posts based on carbon fibres reinforcement principle.

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❑ Endodontically treated teeth are weakened due to decreased or altered tooth
structure attributed to:
◆ caries and/or previous restorations
◆ fracture or trauma
◆ endodontic access and instrumentation
◆ decreased moisture
Dentinal toughness
Collagen alteration
Altered esthetic characteristics
Loss of Neuro-sensory feedback

The weakness is directly correlated to the quantity of lost dentine.

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❑ TREATMENT GOALS

to maintain the coronal and apical seal of the root canal filling
material
to protect and preserve remaining tooth structure
to provide a supportive and retentive foundation for the placement
of a definite restoration
to restore function and esthetics.

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PRE TREATMENT EVALUATION

PROSTHODONTIC CONSIDERATIONS

1.Extent of coronal structure

2.Tooth type (anterior or posterior)
3.Position in arch, morphology , circumference of tooth, occlusal and
prosthetic forces applied to tooth , periodontal support

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ESTHETIC CONSIDERATIONS

1.Gingiva may transmit a dark shadow of the root through the

tissue

2.Metal or dark carbon fibres placed in the canal can result in

unacceptable gingival discolouration

3.Restoration material has to be selected so as to provide the best

health service with minimum of esthetic compromise

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Post & Core

❑ A one-piece foundation restoration for an endodontically treated tooth that

comprises a post within the root canal and a core replacing missing coronal
structure to form the tooth preparation (GPT 9)

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INDICATIONS FOR POST

 To retain the restoration

 To protect remaining tooth structure
 Marginal integrity
 To stabilize radicular fractures

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Indication in anterior teeth

❑ Anterior teeth must resist lateral and shearing forces &

pulp chamber is too small to provide adequate retention and resistance

amount of coronal tooth structure and the functional requirements of the

tooth determines whether is a need for the post

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In posterior teeth - premolars

❑ Premolars are usually bulkier than anterior teeth, but often are single-rooted
teeth with relatively small pulp chambers and are more likely than molars to
be subjected to lateral forces during mastication.
❑ For these reasons, they require posts more often than molars.
• A post may be indicated if a premolar will function as an abutment for an
RPD or suffers from an attachment loss
• The canal anatomy of premolars is delicate and in order to succeed, the post
system chosen must require minimal reshaping and enlargement of the canal
space.
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 In posterior teeth - molars

❑ Endodontically treated, molar teeth should receive cuspal coverage, but

in most cases, do not require a post

❑ Posts are indicated in molars when large percentage of coronal structure

is missing and teeth are at high risk of fracture

❑ If posts are required, they should be placed only in the largest and
straightest canals--upper palatal and lower distal.

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PRINCIPLES OF POST AND CORE

1) Preservation of tooth structure

a) Preparation of the canal
b) Preparation of the coronal tissue
2) Retention
3) Resistance

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PRESERVATION OF TOOTHSTRUCTURE :
a) Preparation of the canal
Whenever possible, coronal and radicular tooth structure should be
conserved.

In most cases, preparation of a post space should require minimal

removal of additional radicular dentin beyond the requirements for
root-canal treatment.

Further enlargement only weakens the root .

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❑ 6 important features for a successful design

Adequate
apical seal
Extension of
the final
restoration Minimal canal
margin onto enlargement
sound tooth
structure

Vertical walls
Adequate post
to prevent
length,
rotation
Positive
horizontal stop
(to minimize
wedging),
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Preparation of coronal tissue:

❑ The amount of remaining tooth structure is probably the single most

important predictor of clinical success.
❑ If more than 2 mm of the coronal tooth structure remains, then the post and
design plays little role in the fracture resistance of the restored tooth.
❑ Extension of the axial wall of the crown apical to the missing tooth structure
provides what is known as a ferrule and helps to bind the remaining tooth
structure together, preventing root fracture during function

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2) RETENTION:

❑ Post retention refers to the ability of a post to resist vertical dislodging

forces.
❑ Retention is influenced by the
 Canal shape & preparation of canal space
 post’s length
 Post diameter and taper
 post design
 Tooth location in the dental arch
 the luting agent and luting method

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3) RESISTANCE

❑ Resistance refers to the ability of the post and tooth to withstand lateral and
rotational forces.
❑ It is influenced by the
remaining tooth structure
the post’s length and rigidity
the presence of antirotation features
the presence of a ferrule.

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Rotational Resistance
❑ In areas where coronal dentin has been completely lost, a small groove
placed in the canal can serve as an anti rotational element.
❑ The groove is normally located where the root is bulkiest, usually on the
lingual aspect

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FERRULE EFFECT

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The ferrule effect
❑ A ferrule is defined as a vertical band of tooth structure at the gingival aspect
of a crown preparation.
❑ The ferrule should be a minimum of 1 – 2 mm high, have parallel axial
walls, completely encircle the tooth, end on sound tooth structure and not
invade the attachment apparatus of the tooth.

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2 types of ferrule:

❑ Core ferrule – part of a cast metal core

For cast post & core a contrabevel is given collar of metal that encircles the
tooth and serves as a secondary ferrule – independent of crown ferrule .
❑ Crown ferrule – the ferrule created by the overlying crown engaging the
tooth structure. the ferrule must encircle a vertical wall of sound tooth
structure above the margin and must not terminate on restorative material.

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❑ The purpose of a ferrule is to improve the structural integrity of the pulp
less tooth by counteracting functional lever forces, wedging effect of
tapered dowels and lateral forces exerted during insertion of the dowel.

❑ It increases the mechanical resistance of a post/core/crown restoration

by reducing the potential for displacement (labial and axial rotation) and
compressive stresses within labial dentine and the canal wall.

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Consequences of Inadequate Ferrule

 Catastrophic root fracture

 Cement failure and post loosening
 Post fracture

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In those clinical situations where there is insufficient ferrule length,
even where margins are placed subgingivally, surgical crown
lengthening or orthodontic extrusion may be considered.

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Meenakshi et al -Comparative Study on Fracture Resistance of Endodontically
Treated Tooth in relation to Variable Ferrule Heights using Custom Made and
Prefabricated Post and Core
International Journal of Oral Health and Medical Research - 2016
❑ Aim: This invitro study was conducted to evaluate the fracture resistance of
endodontically treated teeth restored with different type of post with variable
ferrule height.
❑ Methods: A total no. of 40 samples were made. The samples were broadly
categorised into two main groups of A & B. These groups were further
divided into 8 sub groups of A1,A2,A3,A4 & B1,B2,B3,B4 of 5 samples
❑ group A CUSTOM MADE CAST POST WITH CORE
group B PREFABRICATED POST WITH METAL CORE
A1 & B1 – 0mm (NO FERRULE) , A2 &B2 – 1mm ,
A3 & B3 -1.5mm , A4 & B4 – 2mm 30
 All the samples were subjected to fracture test at particular load with
universal testing machine.The differences in fracture load between Group A
& Group B are compared by paired student's T test and is highly significant
at the level of 0.001%.

❑ Results: The result of this study revealed that the endodontically treated teeth
samples restored with custom made cast post and core with different ferrule
heights exhibit higher fracture resistance than prefabricated post with metal,
core restored teeth samples.

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❑ Conclusion:
Comparatively the custom made cast post and core with variable ferrule
height, especially 2mm ferrule showed significant fracture resistance than
prefabricated post with metal core.

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METHODOLOGY

❑ Post selection
❑ Removal of endodontic filling
❑ Post space preparation
❑ Preparation of coronal structure
❑ Post fabrication
❑ Core fabrication
❑ Temporization
❑ Try in and cementation
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1) POST SELECTION
❑ Factors influencing post selection
1.Root length 9.Post design
2.Tooth anatomy 10. Post material
3.Post width 11. Material compatibility
4.Canal configuration 12. Bonding capability
5.Amount of coronal tooth structure 13. Core retention
6.Torquing force 14. Retrievability
7.Stresses 15. Esthetics
8. Development of hydrostatic pressure 16. Crown material
Fernandes et al Factors determining post selection A literature review - JPD 2003

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 ROOT LENGTH

❑ Determines length of post

❑ Greater the post length, better the retention and stress distribution
❑ 3-5 mm of GP in the apical region to maintain apical seal
❑ Parallel sided threaded post or Reinforced composite luting agents can
compensate for reduced post length

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 Amarnath et al - Effect of Post Material and Length on Fracture Resistance of
Endodontically Treated Premolars: An In-Vitro Study J Int Oral Health. 2015
PURPOSE of this study was to investigate the in-vitro fracture resistance of
devitalized teeth and mode of failure restored with posts of different materials
and different lengths.
Materials and Methods:
❑ Sixty freshly extracted human mandibular premolars were endodontically treated
and then restored with 1 of 2 prefabricated posts: Stainless-steel (SS) and glass-
fiber (fiber posts [FP]) with intraradicular lengths of 4, 7 or 10 mm (n = 10)
❑ Following core restoration, a static compressive load was applied perpendicular
to the long-axis of the teeth.
❑ Post were cemented with paracore dual resin & core formers were used for core
buildup up to 4mm from coronal tooth floor.

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❑ Initial failure of each specimen was recorded in Newton. The mode of failure
was also determined radiographically.
❑ The data were analyzed using two-way ANOVA and Tukey's post-hoc analysis
with Bonferroni adjustment

CONCLUSION : Fracture resistance of the teeth proportionately increased with

increase in the length of FP while it decreased with that of metal post.
SS posts showed greater fracture resistance than FP when 90° load was applied.
Complete core de-bonding was seen with short length posts
The fracture resistance of endodontically treated teeth was significantly influenced
by the post material and post length

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TOOTH ANATOMY
❑ Root anatomy such as
root curvature,
mesio- distal width,
labio-lingual dimension,
canal structure,
proximal root concavities,
anatomic variations
these factors should be considered inorder to avoid any risk of apical or lateral
perforation

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❑ Gutmann ( JPD -1992) reviewed the anatomic considerations and stated that
roots of maxillary centrals and laterals, and also mandibular premolars have
sufficient bulk to accommodate most post systems.

❑ Clinically, a post in a maxillary anterior tooth is subjected to compressive,

tensile, shear, and torquing forces.

❑ At the dentin-post interface, the forces that tend to dislodge the post are
predominately labially inclined shear forces. studies have suggested resistance
form can be increased with the use of a beveled preparation.

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 POST WIDTH
❑ Post width must be controlled to
preserve radicular dentin
reduce the potential for perforations
permit the tooth to resist fracture.
❑ Stern and Hirshfeld (1973) proportionist approach suggest the post width should
not be greater than one third of the root width at its narrowest dimension.
❑ Halle EB et al ( 1984) preservationist approach suggest that the post should be
surrounded by a minimum of 1 mm of sound dentin.
❑ Pilo and Tamse (2000) conservationist approach advocated minimal canal
preparation and maintaining as much residual dentin as possible .

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Residual Thickness of root in first maxillary premolars with post
space preparation - Journal of Endodontics 1999
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CANAL CONFIGURATION
❑ Post should
 Fit closely
 Aptly conform to canal shape & size
 Less dentin removal
 Enhance fracture resistance

Circular canals – prepared to have parallel walls - parallel prefabricated

posts .
Elliptical canals/excessively flared canals - cannot be prepared to give
parallel walls – taper restricted to 6-8 degrees - custom cast posts or
tapered prefabricated posts
Canal configuration determines whether to use custom designed or
prefabricated post
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 AMOUNT OF CORONAL TOOTH STRUCTURE

❑ The bulk of the tooth above the restorative margin should be at least 1.5mm to
2mm to achieve resistance form

❑ In case of endodontically treated teeth with moderate to severe coronal tooth loss
cast post and cores were more successful whereas, in cases where ample coronal
dentin remains non-metal posts such as a carbon fiber posts were deemed
successful

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 TORQUING FORCE

❑ Torsional forces on the post-core-crown unit lead to loosening and

displacement of the post from the canal

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 STRESSES
❑ Post and core–restored endodontically treated teeth are subjected to
various types of stresses: compression, tensile, and shear.
❑ Of these stresses, shear stress is most detrimental to the restored tooth.
❑ Holmes et al (JPD 1996)have demonstrated that the variation in post
dimension greatly influences shear stresses.
❑ An increase in the post length with diameter kept to a minimum will
help to reduce shear stresses and preserve tooth structure. Thus, the
vulnerability of the endodontically treated tooth to fracture is
decreased.

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 DEVELOPMENT OF HYDROSTATIC PRESSURE
❑ During cementation, an increase in stress within the root canal has been reported
because of the development of hydrostatic pressure. This pressure affects the
complete seating of the post and may also cause fracture of the root.

❑ There is evidence that the fitting stresses can be reduced by careful placement of
the post and by using a proper post design with a cement vent to permit escape of
the luting agent and thus reduce the hydrostatic pressure

❑ Pressure development is also dependent on the viscosity of the cement. The more
viscous the cement, the greater the development of the hydrostatic pressure

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 POST MATERIALS

❑ Wagnild et al (2002) summarized the ideal physical properties of a post that

include:
(1) Maximum protection of the root.
(2) Adequate retention within the root.
(3) Biocompatible / noncorrosive
(4) Maximum retention of the core and crown.
(5) Maximum protection of the crown margin cement seal.
(6) Pleasing esthetics
(7) Radiopaque

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❑ Walton and Torabinejad et al (endodontics principles and practice )
According to shape
•Parallel
•Tapered
According to surface configuration
•Smooth
•Serrated
•Threaded

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According to nature of fit
•Passive
•Active
According to construction
•Custom made
•Preformed

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❑

Custom-cast posts

(i) Gold alloys

(ii) Chrome-cobalt alloys
(iii) Nickel-chromium alloys

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 CUSTOM CAST POSTS:

❑ Indications

When multiple cores are being placed in the same arch.

It is more cost effective to prepare multiple post spaces, make
an impression, and fabricate the posts in the laboratory.

When post and cores are being placed in small teeth, such as
mandibular incisors.
In this circumstance it is often difficult to retain the core
material on the head of the post.

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When the angle of the core must be changed in relation to the post. Prefabricated
posts should not be bent; therefore, the custom-cast post best fulfills this
requirement.

In extremely tapered canal or those with non circular cross section custom cast
post will adapt well

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Disadvantages

❑ Higher rate of root fracture mainly due to the wedging forces

produced by the tapered design
❑ Time consuming and involves an additional laboratory cost
❑ Requires two appointments
❑ Requires temporization between appointments
❑ Risk of casting inaccuracies

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❑ PREFABRICATED POSTS
a) METAL
(i) Stainless Steel
(ii) Titanium
(iii) Brass
b) NON METAL
(i) Carbon-fiber
(ii) Fiber-reinforced
(1) Glass fiber (2) Quartz fiber (3) Woven Polyethylene fiber
(iii) Ceramic and zirconia

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 PRE FABRICATED METAL POSTS
❑ They are very rigid, and with the exception of the
titanium alloys, very strong. Advantages
❑ Titanium posts were introduced in order to Less expensive
compensate for corrosion Less no. of
appointments
❑ Titanium alloys are generally weak and therefore not
suitable for thin posts Disadvantages
❑ Titanium alloys have the same radiodensity as gutta- Dislodgement
percha and are sometimes hard to detect Chemical reaction
radiographically. Difficult to retrieval of
active post
❑ Because they are round, they offer little resistance to
rotational forces
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PREFABRICATED NON METAL POSTS

(1) CARBON FIBRE POSTS

❑ The carbon fibre prefabricated post, introduced in the early Disadvantages:

• no radiopacity ,
1990s, is comprised of longitudinally aligned carbon fibres hence impossible to
embedded in an epoxy resin matrix (approx 36%). detect
radiographically
❑ Studies have shown that the carbon fibre post is “quite stiff • black in colour and
and strong, to a degree comparable to several posts made of are unsuitable for use
beneath all
metal” and to have a modulus about ten times higher than
dentine. However these are still controversial

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❑ 2)GLASS FIBER- REINFORCED post :
Eg: parapost white

• Largely used for highly esthetic restorations, these posts typically are
bonded with resin luting cements and utilize composite cores.
• These posts should not be used if there is less than 2-3 mm of supra-
gingival tooth structure present, if there is parafunction or a deep
overbite.

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 CERAMIC POSTS
❑ In 1989, Kwaitowski & Geller described clinical application of glass ceramic posts
❑ ADVANTAGES :
Esthetic - dentin like shade
Radioopaque ,
biocompatible
Low solubility
DISADVANTAGES :
Low tensile strength – fracture easily – thicker post needed – more dentin
removal
Low fracture strength and fracture toughness .
Removed by grinding if retreatment necessary but is a tedious & risky
procedure.. 58
ZIRCONIA POST
❑ 1994, Sandhaus and Pasche
❑ ADVANTAGES :
Esthetic
Extremely radioopaque
Low solubility
High flexural strength & fracture toughness
❑ DISADVANTAGES:
Zirconia posts cannot be etched - not possible to bond a composite core
material to the post, making core retention a problem.
Grinding is impossible if retrieval necessary for retreatment
Higher incidence of root fracture than fiber posts
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METAL VS FIBRE REINFORCED POST

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Ameet et al - Fracture resistance of endodontically treated permanent anterior
teeth restored with three different esthetic post systems: An in vitro study
Journal of Indian Society of Pedodontics and Preventive Dentistry -2015

❑ Aim:
To evaluate and compare the fracture resistance and mode of failure of
simulated traumatized permanent central incisors restored with three different
post systems including biologic dentin posts.
❑ Materials and methods:
A total of 40 recently extracted human maxillary central incisors with similar
dimensions were decoronated 2 mm above the cemento-enamel junction and
endodontically treated.

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❑ Ten specimens were randomly selected as the Group I - Control group (core
built teeth without intraradicular posts).
❑ The remaining 30 teeth were equally divided and restored with
zirconia (Group II, n = 10),
fiber re-inforced composite (FRC) (Group III, n = 10) and
biologic dentin posts (Group IV, n = 10) using resin bonded cement and
their cores built-up.
These samples were embedded in acrylic resin and then secured in a Universal
Testing Machine and subjected to fracture resistance testing.
The location of failure in the specimens was evaluated using a stereomicroscope

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❑ Results:
Intergroup comparison revealed that the control group and zirconia post
group (522 ± 110 N) demonstrated the least fracture resistance, while dentin
post group (721 ± 127 N) the highest.
Fractures that were repairable were observed in fiber post and dentin post
groups, whereas mostly unrestorable, catastrophic fractures were observed in
the zirconia post group
❑ Conclusion:
Teeth restored with the biologic dentin post system demonstrated the highest
fracture resistance and repairable fractures, closely followed by FRC post
system. The least fracture resistance and most catastrophic fractures were
demonstrated by the zirconia post system.
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 ACTIVE VS PASSIVE POST
❑ Most active posts are threaded and are
intended to engage the walls of the canal,
whereas passive posts are retained strictly
by the luting agent.
❑ Active posts are more retentive than passive
posts, but introduce more stress into the root
than passive posts
❑ They can be used safely, however, in
substantial roots with maximum remaining
dentin
❑ Active posts should be limited to short roots
in which maximum retention is needed
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SELF THREADED POSTS:
• Eg: DENTATUS SCREW

❑ Self-threading posts have a shank (shaft) that is fractionally narrower than the
post channel that is cut into the root and has a thread of wider diameter. Thus, as
the post is screwed into place the threads cut their own counter-channel into the
dentine.
❑ They can be either tapered or parallel in design of which tapered ones are more
retentive but induce high stresses due to the wedging effect and may result in
fracture of the tooth

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PRETAPERED POSTS Eg: Kurer Anchor post

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❑ TAPERED SMOOTH SIDED POSTS • eg: kerr endo post
•Smooth sided tapered posts conform to the original taper of
the root canal preparation, thus conserving tooth tissue and
reducing the risk of post-perforation apically, which is a
potential problem with parallel sided post preparation
• It has been suggested that tapered smooth-sided posts have a
‘wedging’ effect under functional loading and it is this, that
leads to increased risk of root fracture.

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PARALLEL SMOOTH SIDED POSTS Eg: Whaledent Para post, Boston post
❑ Parallel posts produce uniform distribution of stress along the root length and
are reported to be less likely to cause root fractures than tapered posts
❑ They are cemented in to prepared parallel channels.
❑ Parallel posts are proven to be more retentive than tapered posts in case of both
metal and fiber posts

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PARALLEL-TAPERED DESIGN
❑ The post is parallel throughout its length except for the most apical
portion, where it is tapered.
❑ This design permits preservation of the dentin at the apex and at the
same time achieves sufficient retention because of parallel design

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70
MATERIAL COMPATIBILITY

❑ Dissimilar alloys of the post and the core may create galvanic action, which
can lead to corrosion of the less noble alloy.
❑ Of the various alloys used for posts, titanium alloys are the most corrosion
resistant. Alloys containing brass have lower strength and lower corrosion
resistance and, hence, are less desirable
❑ Noble metal alloys are corrosion resistant, but their cost is higher.
❑ But with the availability of nonmetallic post materials, the corrosion factor is
eliminated.

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BONDING CAPABILITY

❑ The bonding of a post to the tooth structure should improve the

prognosis of the post-core restored tooth by increasing post retention
and by reinforcing the tooth structure.

❑ Studies have shown that resin luting agents have good adhesion to
carbon fiber posts and glass fiber posts..The adhesion to zirconia
posts was found to be unsatisfactory.

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❑ It was also observed that to improve retention, the carbon fiber post
did not require any surface treatment as compared with the zirconia
post.

❑ In spite of the creation of microretention on zirconia posts, the

adhesion between the post and resin luting agent was not uniform,
thus indicating that the nature of post material was responsible for the
bonding of the post to the tooth structure.

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CORE RETENTION

❑ Studies have reported that prefabricated metal posts with direct cores made
of glass ionomer, composite, or amalgam are less reliable than a one-piece
cast post and core because of the interface between the post and the core.

❑ As the number of interfaces increase, the potential for failure also increases.

❑ Thayer et al has expressed concern that post and core separation is more
likely to occur when composite is used as core material

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RETRIEVABILITY

❑ Ideally, the post system selected should be such that if the endodontic
treatment fails or the post fractures, it is easy for the clinician to retrieve the
post without substantial loss of tooth structure

❑ Carbon fiber posts have an advantage over metallic,ceramic,zirconia posts in

that the removal is relatively easy, rapid, and predictable.

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2) REMOVAL OF ROOT FILLING MATERIAL
❑ Chemical removal by solvents such as
oil of eucalyptus,
oil of turpentine and
chloroform

Mechanical removal by a
non-end cutting bur such as a Gates-Glidden or Peeso reamer

Thermal removal by a heated instrument such as a lateral compactor

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3 )POST SPACE PREPARATION

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4)PREPARATION OF THE CORONAL TOOTH STRUCTURE

❑ Ignore any missing tooth structure and prepare the remaining tooth as though
it was undamaged.
❑ The facial surface (in anteriors) should be adequately reduced for good
esthetics.
❑ Remove all undercuts that will prevent removal of pattern &Preserve as
much tooth structure as possible.
❑ Prepare the finish line at least 2mm gingival to the core. This establishes the
ferrule.

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5)POST FABRICATION – prefabricated post

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CUSTOM CAST POST FABRICATION

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CUSTOM CAST POST

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 INDIRECT TECHNIQUE
❑ An orthodontic ‘J’ shaped wire is selected & coated
with an adhesive
❑ Canal is lubricated.
❑ Impression material is injected in to the post space
and rigid object is inserted in the canal before initial
set of impression
❑ This method conserves the chair time by delegating
the pattern for post and core to lab

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5) CORE FABRICATION

❑ It can be shaped in resin or wax and added to the post pattern before the
assembly is cast in metal.
❑ This prevents possible failure at the post-core interface.
❑ The core can also be cast onto most prefabricated post systems.
❑ A third alternative is to make the core from a plastic restorative material such
as amalgam, glass ionomer or composite resin.

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CORE MATERIAL

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CORE MATERIALS

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METAL

❑ type III / IV Gold alloys, base metal alloys,

silver palladium alloys
❑ Advantages
• High strength
• Avoids dislodgement
Disadvantages
• More root fracture
• Casting inaccuracies
• Time consuming
• Expensive
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Amalgam core

❑ Advantages:
• High compressive strength
• High modulus of elasticity
• Easy manipulation and placement
• Stable to thermal and functional stresses
Disadvantages:
• Unesthetic
• mercury toxicity
• Tendency to discolor adjacent gingiva
• Tendency to corrode
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Composite resin core
❑ Advantages:
• High compressive strength
• Easy to manipulate
• Esthetic
• Bondable
• Adequate strength
Disadvantages:
• Microleakage
• polymerization shrinkage
• Dimensionally unstable
• Tendency to deform plastically and thus cannot be used in high stress areas
• Isolation 88
Glass ionomercore
❑ Advantages:
• Anti cariogenic
• Chemically adhesive to the tooth
• Small buildups/undercuts
❑ Disadvantages:
• Low fracture resistance
• Low retention to prefabricated posts
• Sensitive to moisture

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Resin modified glass ionomer core
❑ Advantages:
• Properties lie in between composites and GIC
• Anticariogenic
• More adhesive than GIC
• Decreased moisture sensitivity
• Decreased microleakage
❑ Disadvantages:
• Tendency to expand in presence of moisture- can lead to fracture of
ceramic crowns.

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Meltem Coltak et al A comparison of the fracture resistance of core materials
using different types of posts Quintessence Int 2007
❑ Objective: The purpose of this in vitro study was to determine the fracture
resistance of 3 core materials (silver amalgam, resin composite, glass-
ionomer cement) supported by 1 custom cast post (nickel-chromium alloy)
and 2 prefabricated posts (Radix and Safix posts).
❑ Method and materials:
A sum of 45 recently extracted single-rooted human incisors and canines
were placed in 0.5% sodium hypochlorite.
Before the experiments, the anatomic crowns of teeth were removed below
the cementoenamel junction to obtain a standard root length.
The roots were endodontically treated by the manual condensation method.
91
The teeth were randomly divided into 9 groups with 5 samples per group.
The posts were luted in the corresponding root canals with zinc polycarboxylate
cement.
Each core reconstruction was prepared with diamond instruments, and the height
of cores formed was 6.0 mm.
The tooth and post-core combinations were mounted in acrylic resin blocks.
Each tooth and post-core combination was placed in a special jig at a 45-degree
angle to the buccal/lingual axis and then subjected to a load on an electronic
pull-tension-compression testing machine at a crosshead speed of 0.5
mm/min.
Data were analyzed using one-way analysis of variance.

92
❑ Results: The resistance to fracture for prefabricated posts was significantly
higher for resin composite core than for the other post-core combinations (P
<.001). For prefabricated posts, the composite core and amalgam core
materials were significantly stronger than the glass-ionomer core material
❑ Conclusion: The glass-ionomer core with custom post was the weakest post-
core system, while the prefabricated posts (Safix and Radix) with resin
composite and amalgam cores were the strongest post-core systems.

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Bonilla et al Fracture toughness of various core build-up materials
JOURNAL OF PROSTHODONTICS -2000
❑ Purpose: The purpose of this investigation was to compare the fracture
toughness of several core materials.
❑ Materials and methods: Five core build-up materials were tested: (1) glass
ionomer, (2) resin-modified glass ionomer, (3) titanium-reinforced
composite, (4) composite resin with fluoride, and (5) amalgam.
❑ Fracture toughness determinations were made using 3-point flexure of beams
with a central single-edge notch.
❑ The notch was standardized by the use of a special mold into which each of
the materials was condensed.

94
❑ Ten beams of each material were tested on an Instron test machine (Instron
Corp, Canton, MA) at a crosshead speed of 1.25 mm/min.
❑ The maximum loads were determined from which the fracture toughness
values (KIC) were calculated.
❑ The data were analyzed statistically using analysis of variance and t tests.

❑ RESULTS There was no significant difference in the KIC values for the
glass ionomer-based materials, and both of these were significantly lower
than amalgam, titanium-reinforced composite resin, and composite resin with
fluoride

95
6) TEMPORIZATION/PROVISIONAL RESTORATION

❑ To prevent drifting of opposing or adjacent teeth, an endodontically treated

tooth requires a proper provisional restoration immediately following
completion of endodontics.
❑ If a cast post-and-core is made, an additional provisional restoration is
needed while the post and core is being fabricated. This can be retained by
fitting a wire (e.g. a paper clip or orthodontic wire) into the prepared canal.
❑ The restoration is then conveniently fabricated with autopolymerizing resin
by the direct technique.

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CEMENTATION
❑ Five main groups of dental materials are used to cement posts
zinc phosphate
polycarboxylate,
glass ionomers
resin-modified glass ionomers
resin cements
Retention provided by luting cements:
zinc phosphate < polycarboxylate< GIC< resin cements

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LUTING METHOD

❑ Place the luting agent on the post and also in the canal with a lentulospiral, a
paper point, and an endodontic explorer.

❑ After the luting agent is placed in the canal, the post is coated with the luting
agent and inserted.

98
99
Samran et al -Influence of Different Post Luting Cements on the Fracture Strength
of Endodontically Treated Teeth: An In Vitro Study.
European Endodontic Journal -2018

❑ Objective:To evaluate the fracture resistance of endodontically treated

mandibular premolars restored with glass fiber posts using different luting agents.

❑ Methods:Twenty-four extracted single-rooted mandibular premolars were

endodontically treated, and post spaces were prepared to receive fiber posts. They
were assigned to three test groups (n=8) according to the type of cement used for
the cementation of glass fiber posts

100
1 -RC group: adhesive resin cement group (etch and rinse),
2-SC group: self-adhesive resin cement group, and
3- GC group: glass ionomer cement group.
❑ Teeth in all groups were adhesively restored with a composite resin core
material and crowned with Ni-Cr crowns.
❑ All specimens were subjected to tangential loading using a universal testing
machine until fracture at 30°.
❑ Failure loads were recorded, and data were analyzed using one-way ANOVA
followed by Tukey's HSD test

Results:Specimens in the RC group were more resistant (258.3±12.7 N) to

fracture than those in the SC (218.7±11.1 N) and GC (165.4±8.9 N) groups
(P≤0.001) 101
❑ One-way ANOVA indicated that the type of cement had a significant effect
on the fracture resistance of endodontically treated lower premolars

Conclusion:The type of cement that was used to fix glass fiber posts was a
determining factor of the fracture resistance of endodontically treated lower
premolars.

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FAILURES IN POST AND
CORE

Post loosening – mean incidence 5%

Root fracture- 3%
Caries – 2%
Periodontal disease- 2 %
Goodacre et al Clinical complications in fixed prosthodontics JPD - 2003
103
POST REMOVAL TECHNIQUES
❑ 1) Masserann technique
Masserann developed and designed an instrument for
extracting posts or rigid instruments that are broken
deeply within the roots with minimum damage.
2) Eggler post remover
The Eggler device can be easily applied to anterior
teeth and to most first premolar teeth, but its size
prevents it from being used in most second premolars
and virtually all molar teeth

104
❑ 3) Ultrasonic scalers • For posts that extend into the pulp
chamber, vibrations from the ultrasonic scaler are able to
break the cement bond between the canal and the post by
touching the post with the ultrasonic tip.
❑ 4)Gonon post removal technique:
• Free the head of the post from the coronal tooth structure
• The high strength trephine is used to bore and gauge the
protruding post to the exact size of a corresponding
mandrel which is specially manufactured to thread the post
• The extracting pliers are fixed on the mandrel and jaws of
the pliers are expanded by tightening the knurled knob

105
RECENT ADVANCES
❑ Flexi –Post
• Flexi-post is the patented split-shanked,parallel- threaded posts.
• Achieves maximum retention with minimal stress
• Split-shank design absorbs stress of insertion by gradually closing
under pressure.The post conforms & adapts to the root rather than the
root adapting to the post.
Based on the studies “The flexi post system displayed twice the retention
of the other systems evaluated”
• Retention comparable to natural dentin with minimal insertional &
functional stress.
• Available in five sizes 00,0,1,2,3.
106
❑ Ambica et al decided to restore the root canal treatment by using dentine post
and evaluate the fracture resistance in comparison to glass and carbon fibre
post. The experimental dentine posts demonstrated the highest fracture
resistance under static and fatigue loading

❑ Comparative evaluation of fracture resistance under static and fatigue loading

of endodontically treated teeth restored with carbon fiber posts, glass fiber
posts, and an experimental dentin post system: an in vitro study.
Journal of endodontics -2013

107
❑ A custom-made post system utilising silanted glass fibres impregnated with a
semiIPN polymer matrix (everStick Post; Finland) has been also developed
❑ Because of its precuring plastic state, this post can fill the entire space of the
root canal with more reinforcing fibres in the cervical portion using
minimally invasive preparation and increasing the load-bearing capacity as a
potential benefit of this post system

❑ Load-bearing capacity of human incisor restored with various fiber-

reinforced composite posts. Dental Materials -2011
108
❑ Luscent Anchor Post Technique
• The luscent anchor post (Dentatus) is a fiber glass ,
clear resin post
• It is designed to refract & transmit natural tooth
colors for esthetic post & foundations.
• Designed to be placed passively in prepared canals
• Available in 3 diameters

109
❑ Parapost Fiber White Technique
• A resin filled , mono-directional fibers matrix with a flexural modulus that
very closely approximates that of the natural dentin

• White translucent

110
PINJET SYSTEM

❑ Pins are used for the impression making of custom made cast post in both
direct and indirect technique
❑ It is made of polycarbonate material resistant to fracture and it chemically
adheres to the resin material
❑ Allows adjustment of the length also
DIGITAL IMPRESSION FOR POST AND CORE
Amir et al The effect of conventional, half-digital, and full-digital fabrication techniques
on the retention and apical gap of post and core restorations JPD-2018

❑ Purpose of this in vitro study was to compare the retention of posts and cores
fabricated using full-digital, half-digital, and conventional techniques and to
define the accuracy of each technique in terms of the apical gap.
❑ Method and materials 30 newly extracted mandibular first and second
premolar teeth were selected for this in vitro study.
Impressions were made using direct acrylic resin patterns (conventional),
indirect silicone impressions of the intracanal which scanned with a 3Shape
laboratory scanner (half digital), and intracanal scan posts captured with an
intraoral 3Shape scanner (full digital).
❑ Casting and milling were conducted for the conventional impression and
digital scans. The obtained posts were cemented using zinc phosphate cement
❑ A universal pullout test was used to measure retention at a crosshead speed of
0.5 mm/min.
❑ The apical gap of each post in the canals was defined with parallel digital
radiography.
❑ The data were analyzed using the Kruskal-Wallis test and Mann-Whitney
test
Conclusions
❑ The conventional technique was more accurate and resulted in higher
retention than both the full- and half-digital techniques. However, the
retention and gap of all the posts fell within clinical guidelines.
Comparative evaluation of the metal post and fiber post in the restoration of the
endodontically treated teeth
journal of dental research and review -2015
Roshan Uthappa et al
❑ This clinical study compares the metal post and fiber post ins the restoration of the
endodontically treated teeth.
❑ Materials and Methods:
Forty endodontically treated and indicated for the post and core were selected for
the study and divided into 2 groups equally.
In, one group patient's teeth were restored by metal post,
other group patient's teeth were treated by fiber post.
Comparative evaluation was done on follow-up of the patients on the basis of selected
clinical and radiographical criteria.

115
❑ The clinical parameters of evaluation were debonding at the post/core and the
tooth inter phase (marginal integrity), the mobility of the tooth, crown fracture,
and periodontal status. The radiological evaluation parameters were root fracture,
crown fracture, periapical status, and adaptation of the posts in the root canal.
The results were compared using student's t test with the help of IBM
SPSS Statistics 20.
❑ Results: More number of failures was noted in patients whose teeth restored with
the metal post as compared to those of the fiber post, both clinically as well as
radiographically. (Student's t test, P < 0.01).
❑ Conclusion: From the present study, it was shown that fiber post retained restored
teeth has less chances of failure as compared to that of metal post. But the results
of the present study should be supported by carrying out study on large scale.

116
SUMMARY
❑ ANTERIOR TEETH: Significant coronal damage
(a) Undermined marginal ridges. (b) Loss of incisal edge. (c) Coronal
fracture & heavily restored (large or multiple coronal restorations). (d)
Mandibular incisors receiving crowns. (e) Abutments for FPD and RPD.
TREATMENT
1. Post/core
Small circular canal - acceptable to use prefabricated post and resin core
(must have at least 2mm of tooth structure apical to resin core);
however, cast post and core is best treatment
Elliptical / flared canal - custom cast post and core
2. Full coverage crown: Porcelain fused to metal / All-ceramic
117
❑ POSTERIOR TEETH
Significant coronal damage
(a) Little or no remaining coronal tooth structure. (b) High risk of fracture. (c)
FPD / RPD abutment

TREATMENT
Prefabricated post and amalgam / composite core
Custom cast post and core
Full crown (if a crown cannot be constructed then an amalgam foundation
restoration with cuspal coverage as an final or interim restoration)

118
William et al Prosthodontic management of endodontically treated teeth –A review
IJCPD- 2014

119
REFERENCES

• Contemporary fixed prosthdontics Rosenstiel – 4th ed.

• Fundamentals of fixed prosthodontics Shillingburg – 3rd ed
• Tylman’s Theory and Practice of fixed Prosthodontics. 8th edition.
• Fernendes et al Factors determining post selection: literature review. J
Prosthet Dent 2003;90:556-562.
Recent Advance in Post Systems by Widad Ahmed

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❑ Roshan et al Comparative evaluation of the metal post and fiber post
in the restoration of the endodontically treated teeth
journal of dental research and review -2015
❑ Samran et al -Influence of Different Post Luting Cements on the
Fracture Strength of Endodontically Treated Teeth: An In Vitro Study.
European Endodontic Journal -2018

121
❑ Meenakshi et al -Comparative Study on Fracture Resistance of
Endodontically Treated Tooth in relation to Variable Ferrule Heights
using Custom Made and Prefabricated Post and Core
International Journal of Oral Health and Medical Research – 2016
❑ Amarnath et al - Effect of Post Material and Length on Fracture
Resistance of Endodontically Treated Premolars: An In-Vitro Study J
Int Oral Health. 2015

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THANK YOU