Posts & cores at glance!

1. Decision Making in Restoration
of Endodontically-Treated
Teeth
Dr. Mohamed S. Zeglam
BDS, MFDS RCPS(Glasg), MSc (Rest Dent)

2. Contents:
 Introduction
 Types of post
 Ferrule effect
 Fiber posts
 Other than posts !!

3. Introduction
Early literature dating from over two hundred years
ago documents the use of posts made from wood, gold
or platinum.
If adequate retention for the core can be derived from
the use of natural undercuts in the pulp chamber and
canal entrances, then a post should not be used.
Posts have been used to restore non-vital teeth for
many years.
Posts: a means of protecting teeth from fracture?
C. M. E. Tait, D. N. J. Ricketts. A. J. Higgins British Dental Journal 2005

4. Introduction
The chief function of a post is to retain the core.
If adequate retention for the core can be derived from the
use of natural undercuts in the pulp chamber and canal
entrances, then a post should not be used.
A popular thought that the cementation of a metallic post
in a root-treated tooth provides reinforcement. In reality,
the post offers no reinforcement.
Posts: a means of protecting teeth from fracture?
J.M. Whitworth, A. Walls, R. Wassell. British Dental Journal 2002

5. Introduction
Posts: a means of protecting teeth from fracture?
 There are many publications on post
crowns within the dental literature, the
majority of which are laboratory
studies.

9. Ready-made
(pre-fabricated)
costum-made

10. Ready-made
(pre-fabricated)
costum-made

11. Ready-made
(pre-fabricated)
costum-made
Courtesy of Whitworth et al

12. Ready-made
(pre-fabricated)
costum-made
Courtesy of Dr. Marco Ferrari

13. • Non-corrosive
• Readily adjusted
• Able to be removed without difficulty
• Radiopaque
• Minimal removal of tooth structure
• Modulus of elasticity similar to dentin
• Retentive in the canal and to the core
IDEAL REQUIREMENTS:

14. Ready-made posts Cast post

15. Ferrule effect
A ferrule is a band of metal which totally
encircles the tooth, extending 1–2 mm onto
sound tooth tissue to guard against longitudinal
fracture

16. Ferrule effect

17. Ferrule effect

18. Ferrule effect
FerruleNo Ferrule

19. Ferrule effect

20. Ferrule effect

21. Ferrule effect

22. Fibers and dentistry

25. -First introduced in 1990.
-A viable alternative to cast metal posts.
-Modulus of elasticity is similar to that of dentin.
-High success rates without occurrence of root
fracture.
-Time saving & ready-to use (cast post demands extra
clinic & laboratory time).
Fiber posts were rapidly accepted by clinicians.
M. Vano et al. International Endodontic Journal, 39, 31–39, 2006
Fiber posts

26. -Differences in their resin chemistry, fiber
composition, manufacturing processes and
external geometry have resulted in an heterogeneous
family of posts.
-Fibre reinforced posts were introduced based on two
principles:
 Should not be more rigid than dentine
 Have an elastic modulus similar to dentine.
G. Bateman, D. N. J. Ricketts and W. P. Saunders Br Dent J 2003; 195: 43-48
Fiber posts

27. Fiber posts

28. Advantages:
Bonding
Aesthetics
Modulus of elasticity
No corrosion
 Retrievability
 Minimal removal of tooth structure

29. Advantages:

31. Root Fracture

32. Root Fracture

33. Radiopacity

34. Radiopacity

35. RadiopacityTranslucency

36. 1
1) Etch-and-rinse (three steps)
2) Etch-and-rinse (two steps)
3) Self-etch (two steps)
4) Self-etch (one step – one bottle system)
Adhesion to intra-radicular dentin
Four techniques:

37. Courtesy of Dr. Leendert Boksman
Etch-and-rinse
Cementation

38. Courtesy of Dr. Leendert Boksman
Etch-and-rinse
Cementation

39. Cementation
Courtesy of Dr. Leendert Boksman
Self-etch

40. Cementation
Courtesy of Dr. Leendert Boksman
Self-etch

41. Cementation
Courtesy of Dr. Leendert Boksman
Self-etch

42. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• The use of FRC post, combined with proper adhesive
cementation technique can give an excellent solution when
restoring endodontically treated teeth that are prone to
fracture.
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.

43. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• The use of FRC post, combined with proper adhesive
cementation technique can give an excellent solution when
restoring endodontically treated teeth that are prone to
fracture.
• The most frequent failure of FRC is debonding of a post at the
resin cement/dentin interface.
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.

44. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• The bond strength formed by self-adhesive cements is lower in
comparison to that formed with resin cements with etch-and-
rinse adhesives.
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.

45. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• To maximize resin bonding to fiber posts, several surface
treatments have been suggested
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.
salinization
sandblasting
• The efficiency of post salinization is controversial and its contribution to the
retention is of minor importance.

46. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• The best results were obtained when the luting agent was
brought into the post space with lentulo spirals or specific
syringes.
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.

47. Adhesion to intra-radicular dentin
Courtesy of Dr. Leendert Boksman
• The best results were obtained when the luting agent was
brought into the post space with lentulo spirals or specific
syringes.
Fiber reinforced composite posts: literature review 2013 Jul;30(3):6-14, 60.
Frydman G, Levatovsky S, Pilo R.

49. Elasticity

50. The smart application

51. `
Thank you

52. Indications:
1) Where a metal post would jeopardize the
esthetic result.
2) Patients with past history of trauma to the
orofacial region and the placement of a metal
post would put an endodontically treated tooth
at risk of root fracture.
3) Teeth with sufficient remaining coronal
structure so that a 1.5-mm to 2-mm ferrule
can be developed in the crown preparation.
4) Teeth with large root canals where additional
intra-radicular reinforcement of the canal
would be beneficial.

53. Indications:

54. Indications:

75. WHAT TO AVOID
 Tapered, threaded posts should be avoided
at all costs >>>>>>>>> can lead to root
fracture.
Because there are so many different post types on the
market with different morphology (tapered, parallel or
double tapered) and retentive design (active or passive)…

76. WHAT TO AVOID
 Do not cement metal posts with adhesive
luting cements as a routine. This allows some
degree of retrievability.
 Avoid ceramic posts as these do not flex like
quartz-fibre posts. The material is brittle and if
fracture occurs removal is extremely difficult.
 Avoid posts in multirooted posterior teeth
where possible.

77. Other than Posts !
NAYYAR CORE

78. Other than Posts !
NAYYAR CORE

79. Other than Posts !
NAYYAR CORE

80. Some cases

81. Some cases

82. Some cases

83. Some cases

84. Endocrown !!

108. Other uses of posts !!!!!

115. !!!!!

116.  Selection of the most suitable post and
core systems is challenging
 Should be guided by knowledge of their:
Indications
Advantages
Disadvantages
The amount and quality of remaining tooth structure
Aesthetic requirements
Dimitrios Tortopidis et al 2015
Conclusion

117.  The use of cast metallic posts and cores
are recommended to restore severe loss
of coronal tooth structure and to retain
metal-ceramic crowns.
Dimitrios Tortopidis et al 2015
Conclusion

118.  Prefabricated fibre posts and all-ceramic
restorations offer a promising
alternative to the restoration of anterior
ETT with cast metallic posts and
porcelain fused to metal crowns.
Dimitrios Tortopidis et al 2015
Conclusion

119.  The use of fibre posts with resin
composite core is preferred when the
hard dental tissue loss is moderate and
dental aesthetics is of primary concern
Dimitrios Tortopidis et al 2015
Conclusion

120. Thank you