Q U I N T E S S E N C E I N T E R N AT I O N A L
ENDODONTICS
Restoration of endodontically treated teeth:
Criteria and technique considerations
Richard D. Trushkowsky, DDS1
The restoration of endodontically treated teeth is often
required and may represent a challenge as there is no consen-
sus on ideal treatment. The failure of endodontically treated
teeth is usually not a consequence of endodontic treatment,
but inadequate restorative therapy or periodontal reasons.
Prior to the initiation of endodontic treatment the restorability,
occlusal function, periodontal health, biologic width, and
crown-to-root ratio need to be assessed. If acceptable, the
appropriate technique, material, and type of restoration to re-
Key words: core, endodontically treated tooth, post
Caries and trauma are the most frequent causes of irre-
versible pulp damage resulting in root canal therapy. The
restoration of these endodontically treated teeth is often
required and may represent a challenge as there is no
consensus on ideal treatment. However, endodontically
treated teeth have been reported to have a reduced
survival rate compared to vital teeth.1 The failure of end-
odontically treated teeth is usually not a consequence of
endodontic treatment, but inadequate restorative ther-
apy or periodontal reasons.2 Excessive removal of tooth
structure during mechanical instrumentation of the root
canal system, mechanical pressures during obturation,
lack of cuspal protection, and large restorations can
1 Clinical Associate Professor, Associate Director, The Advanced Program for
International Dentists in Esthetic Dentistry, New York University College of Den-
tistry, New York, USA.
Correspondence: Dr Richard D. Trushkowsky, The Advanced Program
for International Dentists in Esthetic Dentistry, New York University Col-
lege of Dentistry, 345 E 24th St, New York, NY 10010, USA. Email: rt587@
nyu.edu
VOLUME 45 • NUMBER 7 • JULY / AUGUST 2014
Richard D.
Trushkowsky
store function need to be considered. Posts are used to provide
retention for the core material and to replace missing tooth
structure. The residual amount of tooth structure will deter-
mine its stability for restoration. The creation of adequate fer-
rule (approaching 2 mm circumferentially is ideal) minimizes
the damaging effects of lateral and rotational forces on the
restoration and post. (Quintessence Int 2014;45:557–567;
doi: 10.3290/j.qi.a31964)
weaken the tooth. The prognosis of endodontically
treated teeth is contingent not only on apical seal but
also on the coronal sealing of the canal thereby reducing
leakage of oral fluids and bacteria into the periradicular
areas (Fig 1).3 The neurosensory response apparatus is
impaired with the removal of the pulpal tissue, which
may result in decreased protection of the endodontically
bacteria
Fig 1 The coronal seal is
important to prevent micro-
leakage. Decementation and
micromovement produce
microleakage. Where there is
presumed shrinkage, the bac-
teria can infiltrate, causing
secondary decay.
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treated tooth during mastication.4 Prior to the initiation
of endodontic treatment the restorability, occlusal func-
tion, periodontal health, biologic width, and crown-to-
root ratio need to be assessed. If acceptable, the appro-
priate technique, material, and type of restoration to re-
store function need to be considered.5 An ideal
permanent restoration should restore esthetics and func-
tion, and protect the endodontically weakened tooth.6
INDICATIONS FOR A POST
The indications for a post have been modified in recent
years based on the advantages of adhesive restor-
ations, which may obviate the need for posts.7 Posts are
used to provide retention for the core material and to
replace missing tooth structure. The residual amount of
tooth structure will determine its stability for restor-
ation. Preparation for pulpal access diminishes mechan-
ical strength by about 5%, but a mesio-occlusal-distal
(MOD) cavity will result in a 63% reduction in strength.7
The importance of the marginal ridge was specified by
Strand et al.8 The loss of tooth vitality does not result in
a substantial change in moisture content compared to
vital teeth.9 Unfortunately, the degree of remaining
tooth structure left to require a post has not been delin-
eated. Preoz et al7 established five classes depending
on the number of axial cavity walls remaining:
• Class 1 teeth have four remaining cavity walls, with
a thickness greater than 1 mm. In this case, it was
felt a post is not necessary and any final restoration
can be utilized.10
• Class II and Class III have two or three remaining
cavity walls. These teeth can possibly be restored
without a post. The use of an adhesive core can
provide adequate fracture resistance without the
need for a post.11
• Class IV teeth have one remaining wall, and the core
material will provide minimal or no effect on the
fracture resistance of the endodontically treated
tooth.12 The use of the tooth as an abutment for a
fixed or removable partial denture will result in
reduced fracture resistance as a consequence of
crown preparation.13
558
• Class V teeth have no remaining walls, and a post
will be required to provide retention for core ma-
terial. A ferrule, which is characterized by a
360-degree metal crown collar surrounding parallel
walls of dentin and extending coronal to the shoul-
der of the preparation, would greatly increase the
fracture resistance of the tooth.14 If a ferrule cannot
be obtained, surgical crown lengthening or forced
eruption may be required.
INDICATIONS FOR A CROWN
Baba and Goodacre15 suggest that most endodontically
treated posterior teeth require a crown for longevity.
However, although crowns improve the success of pos-
terior teeth, this was not demonstrated for anterior
teeth.16 Anterior teeth with minimal loss of tooth struc-
ture can be conservatively restored with composite in
the lingual access opening and no post.17 A post provides
minimal or no benefit for a structurally sound tooth.18
Many classical indications for the use of a crown
have also been questioned.19 Unfortunately, the litera-
ture is equivocal as to the requirement for full cover-
age, although cuspal coverage is often recommended.
Rocca and Krejci20 report that currently available
adhesive techniques permit the use of direct composites
and an endocrown (a circular butt-joint margin and a
central retention cavity inside the pulp chamber, lacking
intraradicular anchorage). The basis of this technique is
to use the surface available in the pulpal chamber to
assume the stability and retention of the restoration
through adhesive procedures. The endocrowns provide
full occlusal coverage and the use of the pulp chamber
increases the available surfaces for adhesion.
A variety of materials can be used including feld-
spathic porcelain, glass ceramic (eg, IPS e.max, Ivoclar
Vivadent), or CAD/CAM blocks of either ceramic or
composite or combinations of the two (Lava Ultimate
Restorative, 3M ESPE). Molars can more readily be uti-
lized in this fashion. Premolars are more in danger if
canine guidance is absent as group function may per-
mit a combination of both axial and shear forces on the
premolar cusps.
VOLUME 45 • NUMBER 7 • JULY / AUGUST 2014

Fig 2 A wide variety of post shapes and materials is available.
Fig 3 An anatomic glass fiber post conforms to the root shape.
DESIGN AND TYPE OF POSTS
Posts can be active (most retentive, eg, ParaPost XT,
Coltène Whaledent; Flexipost, Essential Dental Sys-
tems), passive parallel or passive tapered (least reten-
tive, eg, ParaPost Taper Lux, Coltène Whaledent), dou-
ble tapered (DT Light-Post Illusion X-RO, Bisco), or par-
allel tapered (TENAX® Fiber White, Coltène Whaledent;
ParaPostXP No-Ox, Coltène Whaledent). Regarding post
shape, parallel-sided posts provide better retention,
less stress formation, and increased fracture resistance
than tapered posts.21
Regarding surface design, serrated posts provide
better retention than smooth-sided posts, and
threaded posts provide even better retention (Fig 2).22
An increase in post length has also been shown to
be beneficial, but an apical seal of approximately 5 mm
of gutta-percha is required.23 Excessive length can also
become detrimental as the dentin in the apical third is
very thin and perforation or increasing root fracture can
become a possibility. The length of custom metal posts
is usually recommended as two-thirds to three-quarters
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Fig 4 A glass fiber post provides a degree of light conduction
into the canal and allows more complete polymerization. (Cour-
tesy of Coltène Whaledent.)
of root length, and equal to or more than the length of
the crown to be fabricated.24
Posts can be metallic (either custom cast posts or
prefabricated) or fiber (custom [Fig 3] or prefabricated).
Since their introduction in 1990,25 fiber posts have
changed in shape and mechanical physical properties.
Initially the posts were quartz or carbon fiber but now
most are glass fibers, possessing a translucency that
makes an esthetic restoration more easily obtainable.
They also allow some degree of light transmission so
that dual-cure cement can be used (Fig 4),26 as the
translucency helps to provide adequate polymerization
of dual-cure cements. However, the light intensity at
the apical portion may be inadequate because of the
distance from the light source and the light-scattering
nature of the resin cement and the post. The quantity of
light that is absorbed, reflected, and transmitted seems
to be related to the resin matrix, the fiber composition
of each post, and the intensity of the light source.27
Post shapes have been modified from a retentive
shape to cylindrical or oval, which is more anatomical.
Posts of this type provide better adaptation and
remove less remaining root dentin.28
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Fractured Post Fractured

and Crown Fractured Post root Fractured
and Crown root

Vector of Vector of
Force Force
Vector of Force Vector of Force
a b
Figs 5a and 5b Failure can be more catastrophic with a metal post than a glass fiber post. (a) Potential fracture location with glass
fiber–reinforced composite posts. (b) Potential fracture location with metal posts.

parallel
post
space narrow
walls

Fig 6 An ideal post should fit the

1+ mm 1+ mm <1 mm morphology of the canal and not
remove unnecessary tooth structure.

Teeth restored with metal posts many times fail
catastrophically with root fracture (Fig 5). The most
frequent cause of failure in teeth reconstructed with
fiber posts is not root fracture but debonding of the
post, which can occur at the post-cement interface
and/or between cement and root dentin.29
Boschian et al30 underscored the effect of elastic
modulus of the post material on stresses transferred to
tooth structures as an important factor. They reported
that post materials that have a higher elastic modulus
than dentin are capable of causing dangerous and non-
homogenous stresses in root dentin. The authors con-
cluded that the arrangement that best preserves the
integrity of the root, post, and core unit is when fiber
posts are used for restoration. Unlike cast posts, post
length, post diameter, or taper of the post do not mean-
ingfully affect the adhesion and the long-term behavior
of glass fiber posts. However, the low modulus of elas-
ticity of fiber posts (which is similar to dentin) creates a
root strain similar to that of an intact tooth at 8 to
10 mm, and a shorter length (5 mm) causes reduction of
the absorptive forces of the post system. This creates a
transfer of forces to the less rigid dentin in the cervical
area and possible fracture.31 In addition, glass fiber
posts are biocompatible and their esthetic appearance
does not cause discoloration at the gingival margin.32
Endodontically treated teeth that are used as abut-
ments for fixed partial dentures (FPDs) have a higher
failure rate than vital abutment teeth.33 The FPD can
consist of a short span, long span, or be cantilevered.

560 VOLUME 45 • NUMBER 7 • JULY / AUGUST 2014


These abutment teeth undergo both horizontal and
torqueing forces when used for FPDs or removable
partial dentures (RPDs).33,34
CEMENTS AND CEMENTATION
The main reason for failure of glass fiber posts is
debonding, which occurs mainly because of the diffi-
culties in achieving proper adhesion to intraradicular
dentin and to the post.35 Posts cemented with compos-
ite cements exhibit enhanced retention, and the roots
are more fracture-resistant because of more uniform
stress distribution.36
Dual-cured resin cements and adhesive systems are
usually suggested as merging self-curing and light-
curing. Despite the use of two initiation systems by
some products, adequate light transmission is required
to get light activation and the best results.37
Self-adhesive cements have been promoted as
being simpler and less technique-sensitive, but some of
them demineralize the dentin, and the depth of resin
penetration is not equivalent. In addition, residual
acidic monomers may be present, reducing adhesion
capabilities.38 However, some studies favor the use of
self-adhesive cements.39 The retention of glass fiber
posts that had been pretreated with silane has been
reported to be higher compared with posts that were
not pretreated or that were pretreated with other prod-
ucts.40 However, fiber-reinforced posts that have highly
cross-linked polymers in the matrix do not have func-
tional groups that can chemically interact with silane.
Microabrasion with 50-mm aluminum oxide at 2.8
bar (0.28 MPa) pressure for 5 seconds has also been
shown to increase surface area and minimize damage.41
Another problem is the bond to intraradicular dentin,
as it is variable. The number of tubules declines toward
the apical region, and the ratio between the peritubular
and intertubular dentin changes significantly from the
apical to the coronal third.42
An ideal adaptation of the post is a crucial factor for
an adequate cement thickness, as the clinical success of
a tooth rebuilt with a glass fiber post is given mainly by
its ability to limit root dentin removal and to fit to it.
VOLUME 45 • NUMBER 7 • JULY / AUGUST 2014
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Fig 7 Fiber post with sur- Fig 8 Fiber post with acces-
rounding Quartz Splint Unidi- sory Fibercones. (Courtesy of
rectional. (Courtesy of RTD RTD Dental.)
Dental.)
The availability of fiber posts with different shapes
reflects the different morphologies of human root
canals that they need to fit (Fig 6). Root canal cross-
sectional shapes can be classified as round, oval, long
oval, flattened, or irregular. Among these, the oval and
long oval shapes are the most common. Recently, a
new type of fiber post and fiber mesh (Fibercone, a
small, slender fiber post, and pre-cut sections of Quartz
Splint Unidirectional; RTD) that address the problem of
restoring wide, oval, flared, or otherwise large or irregu-
larly shaped root treatment spaces in combination with
a master fiber post and any resin cement and core com-
posite, has been introduced to avoid excessive removal
of residual dentin and to obtain a more uniform
cement layer (Figs 7 and 8).43 If the post does not fit
well, there will be an excessively thick layer of cement,
especially at the coronal level, where air bubbles or
voids could be incorporated, predisposing to debond-
ing. Many authors have investigated the influence of
cement thickness on the bond strength of fiber posts.
As yet, there is no agreement in the literature on the
ideal cement thickness or on the influence of voids
(gaps, air bubbles, emptiness within the cement layer,
or at the post-cement and cavity-wall–cement inter-
face) on the bond strength of fiber posts and their clin-
ical consequence.
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The application of NaOCl could act as a polymeriza-
tion inhibitor of resin materials due to the formation of
an oxygen-enriched dentin surface.44 However, NaOCl
is the most commonly used irrigant because it has the
ability to remove the smear layer, which is created on
the dentin surface during the post space preparation.
The removal of the smear layer, which contains organic
and inorganic components, sealer and gutta-percha
remnants, microorganisms, and infectious deteriorated
dentin is necessary for the penetration of the adhesive
system and resin cement into the dentin tubules.45 Ide-
ally the root canal should be irrigated with chlorhexi-
dine (eg, Endo-CHX, Essential Dental Systems) or sterile
saline solution before post cementation in order to
eliminate the negative effect of NaOCl on the adhesive
bond to dentin. The smear layer, consisting of sealer
and gutta-percha remnants, is plasticized by the heat of
the drill bur during the post space preparation, and can
act as insulation against any kind of adhesive material
intended to bond to the root canal dentin.46 In addition,
this smear layer can also reduce the chemical action of
orthophosphoric acid to provide an ideal bonding sub-
strate. GuttaFlow (Coltène Whaledent) can be used to
fill the canal, and this contains a silicone that can also
make the smear layer more resistant to acid etching.47
FERRULE
A dental ferrule is an encompassing band of cast metal
around the coronal surface of the tooth. The ferrule may
resist stresses such as functional lever forces, the wedg-
ing effect of tapered posts, and the lateral forces exerted
during the post insertion.48 Some clinicians interpret the
ferrule as the amount of dentin above the finish line but
it is the definite bracing of the crown encompassing the
tooth structure that establishes the ferrule.
Eissmann and Radke49 discussed the importance of
the ferrule effect for preventing tooth fracture and rec-
ommended a ferrule height of at least 2 mm. Libman
and Nicholls50 compared the effect of different ferrule
heights (0.5, 1.0, 1.5, and 2.0 mm) of a maxillary incisor
under fatigue loading. They found the minimum
1.5-mm ferrule height meaningfully improved crown
562
resistance. This in vitro study tested the breakage of
cement seal (which can lead to secondary caries, crown
dislodgement, or tooth fracture) in a clinically pertinent
manner using dynamic repetitive loading.50 In addition,
ferrule effect increases the post/core ratio and prevents
the luting cement from being washed away, in turn
improving post retention. Hsu et al51 demonstrated that
the total bonding area between dowel-core and tooth
structure meaningfully influenced crown resistance. It
was demonstrated that the type of cement used for
both the dowel-core and crown can significantly affect
the durability of the restoration and the tooth.51 Unfor-
tunately, many of these studies were done on maxillary
central incisors and may not pertain to posterior teeth.
There are many factors that have to be considered in
the effectiveness of the ferrule: ferrule height, ferrule
width, number of walls, ferrule location, type of tooth,
lateral loads, type of post, and type of core material.52
Ferrule height
Most studies have indicated that a ferrule height of 1.5
to 2 mm of vertical tooth structure would be the most
beneficial.53 The crown should encompass at least
2 mm past the tooth core connection to achieve the
most protective ferrule effect.54
Ferrule width
Esthetic restorations often require fairly aggressive
preparations at the gingival margin and sometimes
buccal defects such as abfraction may compromise the
buccal dentin wall. Generally it has been accepted that
the walls are considered too thin if they are less than
1 mm in thickness, and would negate the ferrule effect.
Therefore crown lengthening on teeth with conical
roots may add dentin height but the dentin width at
the margin may not be adequate.
Number of walls and ferrule location
A circumferential ferrule would be optimal but caries
may affect the interproximal areas and abrasion or ero-
sion the buccal walls. A crown preparation will further
reduce the wall thickness and only a partial ferrule will
remain. Al-Wahadni and Gutteridge55 found having a
VOLUME 45 • NUMBER 7 • JULY / AUGUST 2014

3-mm ferrule on the buccal aspect was better than hav-
ing no ferrule at all. It created a significantly higher
resistance to fracture.55 Ng et al56 proposed that the
location of the sound tooth structure to resist occlusal
forces is more significant than having a circumferential
dentin wall. The authors demonstrated that the pres-
ence of a palatal wall allowed resistance of forces
applied in function to a maxillary incisor. A maxillary
incisor with three walls present but no palatal wall
demonstrated poor fracture resistance.56 This may indi-
cate that a partial ferrule provides a degree of fracture
resistance, although it is not as ideal as a 360-degree,
2-mm ferrule.
TYPE OF TOOTH AND
DIRECTION OF LOAD
Anterior teeth are loaded non-axially while posterior
teeth usually are loaded in an occluso-gingival direc-
tion. Lateral forces usually are more detrimental to the
tooth restoration interface. The restoration of anterior
or posterior teeth may require an altered approach.
Anterior teeth with a deep overbite and parafunction
are at a higher risk of failure. Posterior teeth with differ-
ent occlusal arrangements and cuspal heights affect
the direction and nature of the load applied to each
tooth. Teeth that are in group function with long maxil-
lary buccal cusps produce higher lateral forces than if
there was canine guidance. As the cusps wear, lateral
forces may be converted to vertical trajectories.57
TYPE OF POST
Clear guidelines for the selection of the type of post are
lacking.7 However, the existence of a 1.5- to 2-mm fer-
rule of sound coronal tooth structure is more important
than the post itself.58 Cast posts have been used for
many years for the support of the final restoration.
However, in recent years this type of restoration has
been progressively replaced by composite cores with a
glass fiber post or metal post.59 Fiber-reinforced posts
have found favorable use, notwithstanding their sig-
nificantly lower bearing values. Their performance is
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favorable because this type of post is shielding the
remaining tooth structure by failing in a more non-
catastrophic form (Fig 5).
FIBER POST CEMENTATION AND
CORE BUILDUP
The literature on when to prepare the post space is
inconclusive. Gutta-percha or Resilon (eg, Epiphany,
Pentron Clinical Technologies) are removed with heat
(eg, System B, Sybron Endo) or with rotary instru-
ments.60 Ideally there should be minimal enlargement
of the canal past that incurred during endodontic
instrumentation.
1. Select prefabricated post suitable for both the tooth
and the restoration being utilized.
2. Prepare the coronal residual tooth structure to
accommodate the crown with a minimal wall thick-
ness ≥ 1.5 mm and determine if the post is going to
be fabricated by direct or indirect means depending
on residual tooth structure.
3. Determine the prerequisite preparation depth and
mark this length on the corresponding instruments
with silicone stoppers.
a. The remaining root canal filling from the post
terminus to the apex should be no shorter than
4 mm.
b. The length of the post within the canal should
be at least equal to coronal length of the final
restoration.
4. Remove the root canal filling with a Gates-Glidden
or Peeso reamer to the desired length.
5. Prepare the post space to the same depth with the
appropriate size drill that corresponds to the size
post selected.
6. If necessary apply antirotation protection.
7. Rinse the canal and flush with alcohol.
8. Clean the canal with a CanalBrush (Coltène Whale-
dent) or similar.
9. Check proper fit of the post
10. Shorten the post as necessary with rotary diamonds.
11. Fiber posts should be cleaned with phosphoric acid
for 60 seconds then washed and dried. Metal posts
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Fig 9 After etching with phosphoric acid, Fig 10 A dual-cured bonding agent Fig 11 The bonding agent is placed in
the canal should be rinsed and dried with should be mixed and placed in the canal. the canal with a cylindrical microbrush.
high volume suction. (Courtesy of Premier (Courtesy of Premier Dental.) (Courtesy of Premier Dental.)
Dental.)

Fig 12 An endo-tip allows the dual cure
cement to be placed in the canal without
bubble formation if it is kept immersed.
The post is placed immediately. (Courtesy
of 3M ESPE.)
Fig 13 An automix syringe with two dif- Fig 14 The final core build is cured for 40
ferent diameter tips expedites both place- seconds. (Courtesy of Premier Dental.)
ment of cement into the canal and the
core build-up. The cement is then allowed
to self-cure or it can be light-cured for 20
seconds. (Courtesy of Premier Dental.)

can be micro-etched and a metal primer applied
(eg, Alloy Primer, Kuraray).
12. Some fiber posts benefit from silane application (eg,
Monobond-S, Ivoclar Vivadent) for 60 seconds.
13. Air dry and do not touch with fingers.
14. Adhesive cementation of the post can be with
either a dual- or self-curing luting composite (eg,
Multilink Automix or Variolink II, Ivoclar Vivadent). A
total etch, self-etch, or an adhesive cement can be
used (eg, RelyX Ultimate Adhesive Resin Cement,
3M ESPE). If a total etch is used, place 37% phos-
phoric acid in the canal for 10 to 15 seconds. Irrigate
with water in an irrigating syringe, then use the
high volume vacuum and a paper point to dry the
canal (Fig 9).
15. Use the specific instructions of the cementation
system. If an adhesive is used (Fig 10), a paper point
or preferably an endo brush is used to place the
dual-cured adhesive in the canal and remove excess
(longer cylindrical shape) (Fig 11).
16. If available, use an endo-tip to place the cement into
the canal (Fig 12). Immediately place the fitted post.
17. If a dual-cure luting cement is used, polymerize for
20 seconds from the occlusal aspect of the post and
as near to the post as possible, or wait 5 minutes to
allow self-curing initially and then light cure (Fig 13).
18. Ideally the core can be built up using the same lut-
ing material. After proper contour is achieved of the
dual-cure material, light cure for a final 40 seconds
(Fig 14). A highly filled core such as MultiCore Flow
or MultiCore HB (Ivoclar Vivadent) can be sculpted
as it is placed.
19. The tooth is then prepared for the final restoration
located on 2 to 3 mm of natural tooth structure.

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11 mm
9 mm 1.5 mm
7 mm (min.)

Figs 15a to 15e The ParaPost direct

technique for a cast post. (a) Post space
5 mm preparation. (b) Keyway. (c) Direct wax-
a b c d e up on burnout post. (d) Provisional
crown with temporary post. (e) Final
cast post and core. (Courtesy of Coltène
Whaledent.)

Fig 16 A plastic post with GC Pattern Fig 17 The pattern Fig 18 The cast post Fig 19 The cast post is then cemented
Resin is used to shape the post and is removed from the duplicates the pattern and the preparation refined.
core. mouth to be cast. previously formed.

11 mm
9 mm 1.5 mm Figs 20a to 20e The ParaPost indirect
7 mm (min.) casting system will allow the laboratory
to create the post pattern. This is espe-
cially useful if multiple teeth are
involved. (a) Post space preparation. (b)
5 mm Impression with impression post. (c)
a b c d e
Provisional crown with temporary post.
(d) Wax-up with burnout post. (e) Final
cast post and core. (Courtesy of Coltène
Whaledent.)

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Alternatively a cast post can be fabricated directly
(Figs 15 to 19) using Pattern Resin LS (GC America) and
ParaPost Burnout Posts - Serrated and Vented (ParaPost
XP Casting System-Plastic Burnout, Coltène Whale-
dent), or an indirect casting technique with an impres-
sion post (ParaPost XP Casting System) (Fig 20).
CONCLUSION
The restoration of endodontically treated teeth encom-
passes many different materials and techniques. There
is no consensus of opinion on the need for a crown,
and in the anterior with only a lingual access a compos-
ite restoration will suffice. Posts are only indicated
where inadequate tooth exists to retain a core if a
crown is required. Preparation for a post should wher-
ever possible maintain coronal and radicular tooth
structure. No post is ideal for all clinical situations and
the selection of a post should depend on the tooth pos-
ition in the arch, possible abutment, and occlusion. The
post should provide all the mechanical requirements to
restore the tooth. The creation of adequate ferrule
approaching 2 mm circumferentially would be ideal
and minimize the damaging effects of lateral and rota-
tional forces on the restoration and post.
REFERENCES
1. Hämmerle CHF, Ungerer MC, Fantoni PC, Bragger U, Burgin W, Lang NP.
Long-term analysis of biologic and technical aspects of fixed partial dentures
with cantilevers. Int J Prosthodont 2000;13:409–415.
2. Vire DE. Failure of endodontically treated teeth: classification and evaluation.
J Endod 1991;17:338–342.
3. Heling I, Gorfil C, Slutzky H, Kopolovic K, Zalkind M, Slutzky-Goldberg I. End-
odontic failure caused by inadequate restorative procedures: review and
treatment recommendations. J Prosthet Dent 2002;87:674–678.
4. Randow K, Glantz P. On cantilever loading of vital and non-vital teeth. Acta
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