Guide:

Dr.Rameshkumar.M
ProI & H.O.D
Coguide:
Dr.Sobha.K
Asso. proIessor
DEPT. OF CONSERATIVE DENTISTRY & ENDODONTICS
GOVT. DENTAL COLLEGE
CALICUT
Presented by:
Dr.Chandrababu.K
III MDS
P 1he goal of denLal LreaLmenL ls Lo provlde opLlmal oral
healLh esLheLlcs and funcLlon
P 1he LooLh sLrucLure LhaL remalns afLer endodonLlc
LreaLmenL has been undermlned and weakened by
prevlous eplsodes of carles
fracLure
LooLh preparaLlon
resLoraLlon
P 1hese changes lead Lo fracLure suscepLlblllLy and
decreased Lranslucency ln nonvlLal LeeLh
7arIous methods of restorIng pulpless teeth have been
reported for more than 200 years.
ln 1747, Perre Fauchard descrIbed the process by whIch roots
of maxIllary anterIor teeth were used for the restoratIon of
sIngle teeth and the replacement of multIple teeth
Posts were fabrIcated of gold or sIlver and held In the root
canal space wIth a heatsoftened called "mastIc."
PorcelaIn pIvot crowns were descrIbed In the early
1800s by a wellknown dentIst of ParIs, 0uboIs de Chemant
Dne of the best representatIons of a pIvoted tooth appears In
ental Physoloyy and Suryery, wrItten by SIr John Tomes In
1849 5 Tomes's post length and dIameter conform closely to
today's prIncIples In fabrIcatIng posts
P #estoratIve treatment decIsIons depend on
W The amount of remaInIng tooth
structure
W The functIonal demands that wIll be
placed on the tooth
WThe need for the tooth as an abutment
In a larger restoratIon
PosterIor teeth carry
greater occlusal forces than
anterIor ones
restoratIons must be
planned to protect
posterIor teeth agaInst
fracture.
The horIzontal and torquIng
forces endured by
abutments for FP0 or #P0
more extensIve protectIve
and retentIve features In
the restoratIon
P The post, the core, and theIr lutIng or bondIng agents
together form a foundatIon restoratIon whIch support a
coronal restoratIon for the endodontIcally treated tooth
P The post (dowel) Is a metal or rIgId restoratIve materIal
placed In the radIcular portIon of a nonvItal tooth.
P t functIons prImarIly to aId retentIon of the restoratIon
and secondarIly to dIstrIbute forces along the length of the
root.
P The dowel thus has a retentIve role but does not
strengthen a tooth.
P AnterIor Teeth
restored conservatIvely
wIth a bonded
restoratIon In the
access openIng.
teeth wIth mInImal
loss of tooth
structure
endodontIcally
treated anterIor
tooth whIch Is to
receIve a crown
a post Is often
IndIcated
AnterIor teeth must resIst lateral and shearIng types of forces, and
the pulp chambers are too small to provIde adequate retentIon
and resIstance wIthout a post
olars must resIst prImarIly vertIcal forces.
EndodontIcally treated, molar teeth should receIve .:spaI
.overage, but In most cases, do not requIre a post.
f the destructIon of coronal tooth structure Is extensIve ,those
molars requIre a post
ore than one post Is rarely requIred In a molars
P oIars
The post should be placed In the largest, straIghtest canal,
whIch Is the palatal canal In the maxIllary molars and a
dIstal canal In the mandIbular molars
P !remoIars
Premolars requIre posts more often than molars,because:
W They are usually bulkIer than anterIor teeth, but
often are sInglerooted teeth wIth relatIvely small
pulp chambers.
W Hence, Premolars are more lIkely than molars to be
subjected to lateral forces durIng mastIcatIon.
8ecause of the delIcate root morphology present In some
premolars, specIal care must be exercIsed when
preparIng a post space.
P #etentIon and #esIstan.e
S Post retentIon refers to the abIlIty of a post to
resIst vertIcal dIslodgIng forces.
S #etentIon Is Influenced by
O the post's length
O dIameter and taper
O the lutIng cement used
O whether a post Is actIve or passIve.
P ncreasIng the length and dIameter of the post
can Increase retentIon.
P Parallel posts are more retentIve than tapered
posts.
P ActIve posts are more retentIve than passIve
posts .
P 0Iameter Is less Important than the other
factors lIsted
P#esIstan.e refers to the abIlIty of the post and
tooth to wIthstand lateral and rotatIonal forces.
P t Is Influenced by
S the remaInIng tooth structure
S the post's length and rIgIdIty
S the presence of antIrotatIon features
S the presence of a ferrule.
P A restoratIon lackIng resIstance form Is not lIkely
to be a longterm success, regardless of the
retentIveness of the post
P t Is an Important factor related to resIstance
P All post systems have some percentage of
clInIcal faIlure.
P some posts cause a hIgher percentage of faIlures
that result In teeth that are nonrestorable.
P Teeth restored wIth less rIgId posts(eg.fIber
posts) tend to have faIlures that are more lIkely
to be restorable.
P Teeth prepared wIth a ferrule also tend to faIl In
a more favorable mode.
P The type of core materIal also can affect faIlure
mode.
P PIlo et al. reported that composIte cores tended
to faIl more favorably than amalgam or gold.
P henever possIble, coronal and radIcular tooth structure
should be conserved.
P n most cases, preparatIon of a post space should requIre
mInImal removal of addItIonal radIcular dentIn beyond the
requIrements for rootcanal treatment.
P cemented metal posts do not strengthen the root.
P 8onded posts are reported to strengthen the root InItIally,
but thIs strengthenIng effect Is probably lost over tIme as
the tooth Is exposed to functIonal stresses and the resIn
bond to dentIn weakens.
P A ferrule Is defIned as a vertIcal band of tooth structure at
the gIngIval aspect of a crown preparatIon.
P t adds some retentIon, but prImarIly provIdes resIstance
form and enhances longevIty.
P StankIewIcz and Ilson In 2002 showed that a ferrule wIth
1 mm of vertIcal heIght has been shown to double the
resIstance to fracture versus teeth restored wIthout a
ferrule.
P A study by alHazaImeh and CutterIdge reported no
dIfference In fracture resIstance wIth or wIthout a 2mm
ferrule usIng prefabrIcated posts and resIn cement.
P However, the fracture patterns were more favorable when
a ferrule was present.
P The majorIty of the fractures In the teeth wIthout a
ferrule were nonrestorable.
P n some cases, partIcularly wIth anterIor teeth, It Is
necessary to perform crown lengthenIng or orthodontIc
eruptIon of a tooth to provIde an adequate ferrule.
P n most cases, metal posts can be removed effectIvely and
safely.
P A case serIes by Abbott reported only one root fracture of
1600 posts removed.
P ost fIber posts also are reported to be easy to retrIeve.
P ceramIc and zIrconIum posts are consIdered to be very
dIffIcult and sometImes ImpossIble to retrIeve.
P #etrIevabIlIty should be consIdered when treatment
plannIng a post.
#eadymade (prefabrI.ated)
C:stom made
P A..ordIng to the materIaIs:
etal
StaInless steel
TItanIum
NonetaI
FIbrous core
CeramIc
Carbon fIber
P A..ordIng to the o:ter s:rfa.e:
Serrated
Smooth
Screw
P A..ordIng to the shape:
Parallel sIded
Tapered (root formed
Core
Cast etal
Noble 8ase metal alloy
Amalgam
Non etal
ComposIte
PorcelaIn
Class Ionomer
ost actIve posts are threaded
Intended to engage the walls of
the canal
ActIve posts are more retentIve
more stress
passIve posts are retaIned
strIctly by the lutIng agent.
Less retentIve
Less stress
8rand Name 1ype of ost Manufacturer
P 9osL arbon flber 81u/8lsco
P AesLheLl9lus CuarLz flber 81u/8lsco
P u1 LlghL9osL CuarLz flber 81u/8lsco
P llbrekor Class flber !enerlc/9enLron
P osmoposL Zlrconlum vlvadenL
P uenLaLus meLal posL 8rass LlLanlum uenLaLus
P LucenL Anchor Class flber uenLaLus
P 9araposL SLalnless sLeel LlLanlum olLene/WhaledenL
P 9araposL WhlLe Class flber olLene/WhaledenL
8rand Name 1ype of ost Manufacturer
P vLock 1lLanlum 8rassler
P llexl9osL 1lLanlum LssenLlaluenLalSysLems
P Parallel metal posts are more retentIve than
tapered posts
P ThIs also Is reported to be true for fIber posts .
P Parallel posts Induce less stress Into the root,
because there Is less of a wedgIng effect, and
are reported to be less lIkely to cause root
fractures than tapered posts.
P n a retrospectIve study, Sorensen and artInoff
reported a hIgher success rate wIth parallel
posts than tapered posts.
P Tapered posts, on the other hand, requIre less
dentIn removal because most roots are tapered.
P They are prImarIly IndIcated In teeth wIth thIn
roots and delIcate morphology.
P Advantages: HIgh retentIon
P 0Isadvantages:
Stresses generated In canal may lead to fracture
Not conservatIve of coronal and radIcular tooth structure
P #ecommended Use: Dnly when maxImum retentIon Is
essentIal
P PrecautIon: Care to avoId fracture durIng seatIng
P typIcally made of staInless steel, nIckel
chromIum alloy, or tItanIum alloy.
P very rIgId and wIth the exceptIon of the tItanIum
alloys, very strong.
P 8ecause they are round, they offer lIttle
resIstance to rotatIonal forces.
P ThIs Is not a problem If adequate tooth structure
remaIns, but If mInImal tooth structure remaIns,
antIrotatIon features must be the post
preparatIon wIth slots or pIns.
P A bonded materIal should be used for the core.
P PassIve, tapered posts offer the least retentIon
of the prefabrIcated posts
P 8ut allow mInImal removal of radIcular dentIn
because theIr tapered shape resembles the
overall canal morphology.
P f adequate canal length Is avaIlable, they are a
good choIce, partIcularly In thIn roots such as
maxIllary premolars.
P Adequate length Is consIdered to be greater than
8 mm.
P AddItIonal retentIon can be gaIned wIth a
parallel post, by the use of resIn cement, or by
the use of an actIve post.
P any of the prefabrIcated posts are made of
tItanIum alloys and some are made of brass.
P TItanIum posts were Introduced because of
concerns about corrosIon.
P ost of the tItanIum alloys used In posts have a
radIodensIty sImIlar to guttapercha and sealer
and are sometImes hard to detect on
radIographs.
P TItanIum posts have low fracture strength, whIch
means they are not strong enough to be used In
thIn post channels.
P #emoval of tItanIum posts can be a problem
because they sometImes break when force Is
applIed wIth a post removal Instrument.
P Extended use of ultrasonIc energy may be
necessary to remove tItanIum posts, whIch can
be damagIng to the tooth or surroundIng tIssues.
For these reasons, tItanIum and brass posts
should be avoIded, because they offer no real
advantages over the stronger metal posts
P Cenerally, they do not perform as well as other
types of posts durIng In vItro tests and clInIcal
studIes.
P Some studIes report a hIgh rate of success wIth
cast post and cores, and they offer advantages In
certaIn clInIcal sItuatIons