Is restoration of endodontically treated
tooth necessary?
RESTORATION OF All teeth that are heavily restored are susceptible to
fracture
ENDODONTICALLY The fracture of a non-vital tooth is likely to be more
catastrophic
TREATED TEETH An endodontically treated tooth may have a cavity
depth 3-4 times greater than a vital tooth
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Before deciding endodontic treatment or
Unrestored endodontically treated tooth is retreatment,
structurally compromised and is at greater risk critical treatment planning questions:
A well restored endodontically treated tooth
should have a good prognosis Is the tooth restorable??
Cost and prognosis
Implant option
Is there an available circumferential ferrule??
The importance of Ferrule A minimun dentin height of 1.5-2mm 360º
A Ferrule is a circumferential ring of sound tooth around the crown preparation is
structure beyond the core restoration important
It decreases the wedging effect, lateral forces
and maintains the integrity of the cement
seal of the casting
•1
Adequate ferrule crown and root function as
one unit occlusal forces are transmitted to
the periodontium
Inadequate ferrule occlusal stresses are
transferred to the core and/or post root/post
fracture or post dislodgement
The longer the ferrule the higher the fracture
resistance
Creation of If an adequate ferrule cannot be obtained
ferrule extraction of the tooth is advised
Surgical crown Orthodontic
lengthening extrusion
Assessment must be done to evaluate the
following before planning the restoration: Selecting the restorative modality
1. Adequate canal filling and a good apical seal • Morphologic differences between anterior and
2. No sensitivity to pressure (percussion) posterior teeth
• The amount of remaining tooth structure
3. No apical sensitivity
• The type of restoration planned (e.g., will the tooth
4. No exudates
be an abutment of a fixed or removable partial
5. No fistula denture)
6. No active inflammation • Occlusion and para-functional occlusal habits
7. Evidence of apical healing
DEFINITIONS
1- POST (Dowel) : a post usually made of metal or fiber-reinforced composite resin
that is fitted into a prepared root canal of natural tooth.When combined with post
with a core, it provides retention and resistance for an artificial crown (GPT8)
•2 2- CORE : the foundation restoration which restore sufficient coronal anatomy of a
vital or endodontically treated tooth (GPT8)
Anterior Teeth (Do they need a crown?) Anterior Teeth (Do they need a crown?)
Intact marginal ridges, cingulum, and incisal edges:
Forces are generally lower and tooth fracture is less A composite restoration
common Extensive coronal destruction, large proximal
Endodontically treated anterior teeth do not always restoration / Need for occlusal change /
need a crown Need to improve esthetics:
A crown with post & core
Anterior Teeth (Do they need a post?) Posterior Teeth (Do they need a crown?)
Posterior teeth are more susceptible to fracture
If no crown is required, a post is generally than anterior teeth because:
unnecessary • They are subjected to greater load
If a crown is necessary, a post is generally • Their morphological characteristics (having cusps
required that can be wedged apart)
Posterior Teeth (Do they need a crown?) Posterior Teeth (Do they need a post?)
In general, crowns or cusp coverage are The purpose of a post…
recommended Molars:
• With an adequate pulp chamber do not require a
post
It has been shown that the prognosis for posterior
endodontically treated teeth is significantly
improved with coronal coverage
• With an inadequate pulp chamber will
require a post (which canals to use?)
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Posterior Teeth (Do they need a post?)
A core build-up utilizing the chamber and extending
2mm in the canal is effective
Studies have shown that pulp chamber depth of 2-4mm
offers an adequate retention for an amalgam build-
up without posts
Posterior Teeth (Do they need a post?)
When is the best time to start restoration?
Premolars:
Maxillary premolars: high risk for fracture As soon as possible upon completion of
(Complete coverage is recommended and Posts are endodontic treatment to prevent
generally considered necessary) recontamination and endodontic failure
Mandibular premolars: type of restoration
depends on the amount of remaining tooth
structure Recontamination can occur due to loss of
temporary restorations or leakage of an
inadequate final restoration
Post space preparation
If a final restoration
Post length
cannot be placed within a
few weeks of endodontic • Longer post provide more retention and greater
treatment, a strong, leak- resistant to fracture
resistant temporary
• Short posts lead may be dislodged or lead to root
restoration is indicated fracture
A well fabricated Provisional crown
Glass ionomer, composite build-up filling the whole
pulp chamber
•4
Post diameter
Post length
Variation in diameter is not a major factor in
3-5mm of gutta percha apical seal retention
At least as long as the clinical crown Smaller diameter posts provide greater resistance
2/3 of the length of the root to fracture than larger ones
Ending halfway between crestal bone and apex Larger posts require removal of additional tooth
structure which weaken the tooth
A short root & long clinical crown → 3 mm apical
seal is considered acceptable
The canal should be minimally enlarged
Post diameter should not
Use the smallest post that adopts itself to the canal exceed 1/3 of the cross
sectional root diameter
Be careful not to remove more dentin at the apical
extent of the post space than is necessary The root walls should be
at least 1-1.5mm thick
Practitioner must
consider the decrease of
the root diameter apically
and the presence of
concavities
Prefabricated Posts
Parallel serrated,
smooth or active
Tapered serrated,
smooth or active
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Parallel Tapered
Serrated post has a
• More retentive (only if it • Conforms better to the greater resistance to
fits the canal properly) canal
dislodgement than a
• Distribute masticatory • Requires less removal of smooth post
stress better dentin to achieve an
adequate fit
• Concentrates stresses at
the apex • Have a wedging effect may
lead to root fracture
• Used in roots with Active post causes
circular cross section
greater internal stress
and could lead to
root fracture
• Active post engages the dentin, so that
dentinal threading provides most of Prefabricated posts
retention
• They are the most retentive, their use should Metal posts
be limited to short roots Fiber posts
• Passive fit, the post need not be tight to
Ceramic and Zirconia posts
reduce the amount of stress on the root
Studies show that passive parallel-sided posts are
less likely to contribute to root fracture
Metal posts
• Stainless steal
• Nickel chromium alloy
• Titanium alloy
There is no evidence of superiority of one
over another, except for Titanium which is
less strong
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Fiber reinforced posts Ceramic and Zirconia posts
• Carbon fiber: no radiopacity, • White, radiopaque, rigid
black, stiff, low retention to • Does not bond to composite
composite, post-cement
core
intreface failure
• Can be used with heat-pressed
ceramic core
• Glass fiber, silicone fiber,
Time consuming and more
quartz fiber expensive, more catastrophic tooth
fracture compared to metal
Core Materials
Ideal Features Core Materials
Biocompatible
Have adequate strength and rigidity Amalgam
Highly resistant to bacterial leakage Composite Resin
Insoluble and dimensionally stable in oral fluids
Glass ionomer
Have CTE close to that of tooth structure
Easy manipulation Resin-modified Glass ionomer
Bond to tooth structure
Can be immediately prepared
Custom cast post
Custom cast post and core ▪ Better fit ▪ Takes two appointment
▪ More costly
▪ More uniform thickness
of cement ▪ More tooth structure is
▪ Decreased fracture
removed
resistance of the root ▪ Contamination of the
▪ More rigid root canal system with
the provisional crown
Many studies have demonstrated that
prefabricated and cast posts have relatively equal
performance
•7
A cast post & core is indicated when a prefabricated
post cannot be properly fitted
Post Cementation
In teeth with elliptical
Cement enhances retention, aids in stress
or excessively flared
distribution, and seals micro gaps between the
canals
tooth and the post
Where alignment of
the proposed crown is
significantly different
from the inclination of
the canal
Cements Procedure
Zinc phosphate and Resin Modified GIC offer Restoring an endodontically
adequate retention and resistance to leakage and treated tooth is done in two
simplify post removal stages:
GIC is good but is sensitive to moisture 1. Post space preparation
2. Tooth preparation
Resin cement should be reserved for cases where
post retention is compromised
Fiber posts are designed to be used with resin Radiographic
interpretation almost
cements
always determine post
LENGTH and WIDTH
Post Space Preparation
Choose which type of post you will use
4-5 mm of root canal
filling material must
be retained as the
apical seal Twist drills (end cutting)
Peeso-reamers and Gates-
Mechanical removal Glidden drills are safe tip
with a rotary instruments (non-end cutting)
instrument or with a
hot plugger Enlarge the canal using a drill that matches the
configuration of the post
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Tooth preparation Tooth preparation
Cast post and core Prefabricated
Cast post and core Prefabricated Remove undercuts
Residual wall thickness should be
• Ignore missing coronal structure and prepare the at least1mm
remaining tooth structure as if the crown is intact,
establish the finish line Occlusal clearance enough to
accommodate crown and at least
1mm of core metal
• Remove all unsupported tooth structure Post and core should have
positive occlusal seat to avoid
wedge like action
Tooth preparation
Cast post and core Prefabricated
Direct Indirect
Cast post and core (Direct) Parapost system
Instrument #1 #2 #3 #4 #5 #6
Peeso Reamer 0.7 0.9 1.1 1.3 1.5 1.7
Parapost
Gates Glidden 0.6 0.7 0.9 1.1 1.3 1.5
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Instrument #1 #2 #3 #4 #5 #6
Peeso Reamer 0.7 0.9 1.1 1.3 1.5 1.7
Parapost
0.9mm
1.0mm
1.14mm
1.25mm
1.4mm
1.5mm
1.75mm
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Cast post and core (Indirect)
Fiber post
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