Restoration of endodontically treated teeth is a challenge that most dentists encounter daily. In many cases, endodontic therapy was initiated after significant breakdown from caries and previous restorations.
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One of the main challenges, which has puzzled dentists for years, is finding the most predictable option for restoring endodontically treated teeth and whether or not a post and core should be utilized as part of the treatment plan.
There are misconceptions about using a post when restoring endodontically treated teeth. Some misconceptions include that posts strengthen teeth and help retain a crown. However, neither of these things are true. The sole purpose of a post is to retain the core.1 In many cases, if there is sufficient remaining tooth structure for a core buildup, a post is not necessary.2,3
There are many risks associated with placing a post in an endodontically treated tooth, including perforation during post preparation and tooth fracture due to the removal of dentin within the canal space.1
Due to their anatomy, some teeth are more appropriate for post placement than others. In general, maxillary and mandibular molars are least likely to require a post to retain a core buildup. This is due to the fact that buildup material can be placed in the orifice of each canal to retain the core material.
In the rare instance that insufficient tooth structure remains and a post is required for a molar, the post is typically placed in the palatal canal of a maxillary molar and distal canal of a mandibular molar.
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These canals are preferred because they tend to be the largest and straightest canals of molars. When needed, only one post in a maxillary or mandibular molar is sufficient to retain the core.
Premolar teeth have fewer retentive features than molars and are more likely to require a post to retain the core. However, the anatomy of the canal system must be examined prior to planning placement of the post in order to minimize the risk of perforation in premolars with more complex root morphology.
Anterior teeth are the most likely to benefit from the use of a post. This is because anterior teeth typically present with a single canal and are subject to lateral forces that can dislodge a core if insufficient tooth structure remains. However, if an adequate amount of tooth structure remains to retain the core, a post should be avoided.4
Historically, the cast post and core were utilized in endodontically treated teeth. However, the cast post and core are time-intensive, require two visits and must be fabricated by a lab. As a result, prefabricated posts have gained popularity. There are multiple different materials and designs of post systems currently on the market.
Most modern post systems are composed of either metal or fiber-reinforced materials. Metal posts are generally stronger than fiber posts. Titanium posts have been observed to be the weakest compared to other metal posts (such as stainless-steel posts) and are more difficult to retrieve, so they should be avoided.
Fiber posts have a similar modulus of elasticity as dentin, which minimizes the amount of stress the post places on the root. When fiber posts fail, they are more likely to leave the tooth in a state that is restorable, as opposed to metal posts, which tend to exhibit catastrophic failures that lead to a hopeless prognosis of the tooth.4,5
Fiber post and stainless-steel metal post.Post systems are designed with different retentive features. The retentive aspects of a post can be divided into active and passive posts. Active posts have retentive features that engage the root. This makes them more retentive than passive posts, which passively seat in the canal space and are retained by a cement or bonded in place. However, due to their engaging features, active posts place more stress on the root of the tooth and are only advised for teeth with short roots.
Posts can also have a parallel or tapered design. Parallel posts generally are more retentive than tapered posts, however, more tooth structure must be removed to facilitate the placement of a parallel post.4
Various fiber posts with tapered design.As stated earlier, the only purpose for a post is to retain the core buildup material. With advancements in adhesive dentistry, the need for posts has been decreasing. Some early studies have even shown that there is not a statistically significant difference in failure rates in endodontically treated molars with posts and cores compared to those only consisting of a core buildup.6
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Some companies have discontinued manufacturing their post systems due to decreased use. While posts are still used in severely compromised teeth, the advances in adhesion of core materials and bonded indirect restorations has minimized the need for posts when restoring endodontically treated teeth.
Andy Janiga, D.M.D., is a contributor to Spear Digest.
1. Cheung, W. &#;A review of the management of endodontically treated teeth: Post, core and the final restoration.&#; JADA : 136 (5): 611-619
2. Bitter, K., et al. &#;Randomized clinical trial comparing the effect of post placement on failure rate of postendodontic restorations: Preliminary results of a mean period of 32 months.&#; J Endod : 35: -
3. Ferrari, M., et al &#;Post placement affects survival of endodontically treated premolars&#; J Dent Res : 86 (8): 729-734
4. Schwartz, R.S. and Robbins, J.W. &#;Post placement and restoration of endodontically treated teeth: A literature review&#; J Endod : 30: 289-301
5. &#;Restoration of endodontically treated teeth: The endodontist’s perspective, Part I.&#; AAE, Colleagues for Excellence, Newsletter, Spring/Summer
6. Magne, P., et al. &#;Composite resin core buildups with and without post for the restoration of endodontically treated molars without ferrule.&#; Operative Dentistry : 41(1): 64-75
© The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/ ), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
Early childhood caries is indeed a devastative situation for both patients&#; parents and pediatric dentists. The primary goal in treating severe early childhood caries is to restore normal function such as maintenance of mesiodistal and vertical dimension, prevention of alteration of mastication, phonetics (due to premature loss), development of parafunctional habits, and prevention of psychological problems affecting the self-esteem of a child. The restoration of primary dentition with extensive carious lesions is a complex clinical challenge of several dimensions. The severity of this condition in maxillary anterior teeth has prompted the extraction of teeth due to inadequate esthetic treatment options. The only concern with the severely destructed primary incisors is a lack of crown structure, which fails to support and adhere to a composite crown. Clinicians have preferred many restorative modalities for esthetic rehabilitation of badly decayed anterior primary teeth with numerous root canal retentive post and core systems with appropriate techniques to preserve those teeth until they are replaced by permanent teeth. This review highlights the various posts, their indications, principles, ideal properties, and the current concepts on their use in pediatric dentistry.
The most common chronic disease of childhood is dental caries. Early childhood caries is carious lesions in very young children that clinically show a characteristic pattern. Maxillary central incisors and maxillary lateral incisors are the teeth most commonly involved followed by maxillary and mandibular first primary molars in both maxilla and mandible.1 It is a chronic, irreversible, multifactorial disease whose etiology is frequently associated with night-time feeding (breast or bottle-fed), poor oral hygiene habits, and the consumption of a more cariogenic diet.2 According to the AAPD guidelines, due to the unique and rampant nature of ECC, immediate therapeutic intervention is necessary to prevent further destruction and subsequent health problems.3
Another significant factor that a pediatric dentist is concerned about is trauma. Parents typically visit the dentist when their children's teeth are severely broken and, too often, with root stumps left behind due to inadequate knowledge and lack of awareness on their part, making rehabilitation difficult.4
When sufficient tooth structure remains to be rehabilitated, it can be treated with conservative preparation and the application of a dentin bonding agent followed by preventive resin restoration. When there is sufficient tooth structure the carious coronal tooth structure can be restored with polycarbonate crowns, art glass crowns, anterior strip crowns, and veneered stainless steel crowns.5 Due to the lack of knowledge and awareness among parents, the majority of them consider treatment for their children only when their teeth are grossly broken and mere root stumps remain.
Primary anterior strip crowns were restrained to primary teeth with sufficient enamel, with the newly developed composite and dentinal bonding technique, although they cannot be used in grossly damaged primary anterior teeth with little or no enamel remaining after caries removal.6 But it remains a clinical challenge while restoring primary incisors with extensive carious lesions. For a long period, extraction was the most commonly used treatment for primary teeth with significant coronal destruction.7 These teeth were quite often replaced by fixed or removable appliances, which pose issues with gingival health and patient cooperation. The restoration of grossly destruction maxillary incisors affected by early childhood caries has continued to be a major challenge for a pediatric dentist due to the insufficient amount of tooth structure available for bonding and behavioral problems in young children.8 In those larger lesions where little dental structure is left, conventional restorative procedures have been unsatisfactory and result in the use of prosthodontics appliances. In severely mutilated incisors where there is the involvement of pulpal tissue, pulpectomy has to be carried out and intracanal retention is necessary which allows building a post and core and then cementing an artificial crown. These posts were designed as composite resin posts, with the use of orthodontic pins, and as biological or natural posts.9
In clinical practice, evidence-based intracanal post-selection is very important, and pediatric dentists face significant problems due to the heterogeneity of data available on intracanal posts.
This literature review summarizes the various posts, their indications, ideal properties, and their use in pediatric dentistry.
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