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12-03-09

Restoration of Structurally
Compromised Teeth

Fibre Post Systems


Science & Procedure

an endodontic & prosthodontic


perspective
Dr. Chris Wyatt

Dr. Jeff Coil

Dr. Chris Wyatt

Director of Graduate Prosthodontics


Certified Specialist in Prosthodontics

Director of Graduate Prosthodontics


Certified Specialist in Prosthodontics

Director of Graduate Prosthodontics


Certified Specialist in Prosthodontics

Posts

Posts
Cast Metal Post & Core

The foremost purpose of the dowel is to


provide retention for the core and coronal
restoration. It should also do so without
increasing the risk of root fracture

Prefabricated

METAL

FIBRE
CERAMIC

Pathways of the Pulp


10th Edition, 2011

Posts

INDICATION FOR Post & Cores


IS A POST NECESSARY ?

The amount of remaining dentin is far


more significant to the long-term
prognosis of the restored tooth than is
the selection of artificial dowel, core or
crown material.

No difference between vital and endodontically


treated teeth in sheer strength, vertical load
fracture, and micro hardness (Sedgley, 1992)

Pathways of the Pulp


10th Edition, 2011

12-03-09

Restoring Endodontically
Treated Teeth

INDICATION FOR Post & Cores


INADEQUATE TOOTH STRUCTURE TO

RETAIN A CORE FOR A CROWN

Posts do NOT reinforce structurally sound anterior


teeth (Guzy & Nichols, 1979; Trope et al. 1985) and increase their
chance of non-restorable fractures (Heydecke et al. 2001)
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When do we need a post ?

Ideal Properties of Posts


Maximum

protection of the root


retention within the root
Maximum retention of the core and crown
Maximum protection of the crown margin
cement seal
Aesthetic
High radiographic visibility
Retrievable
Biocompatibility (Corrosion)
Adequate

MINIMAL CORONAL TOOTH STUCTURE

Pathways of the Pulp 10th Edition, 2011


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Crown Ferule Effect

Ideal Properties of Posts


of the total root length
the diameter of the root
4-5mm of gutta percha
Well fitting
Coronal stop
Antirotational

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2/3
1/3

Ferule

Shillingburg & Kessler, 1982

Ferule

Crown = RCT= FRL2mm > FRL0.5 >noFRL

Effect of 1-2 mm

Tan et al. 2005

Sorenson & Martinoff, 1984


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12-03-09

Resistance

Post Length
1:1

The

above:below the bone (Hunter et al. 1989)

1:1

crown:root ratio (Sorenson & Martinoff, 1984)


root length (Goodacre & Spolnik, 1995)
8 mm minimal post length (Neagley, 1969)

ability of the post and tooth to


withstand lateral & rotational forces
- Anterior vs. Posterior Teeth
- Occlusal Forces

Post

Length
Post & Core Rigidity
Anti-Rotational Features
Crown Ferrule
Isador et al. 1999

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RETENTION & RETRIEVABILITY

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FAILURE of Metal Posts

POST DIAMETER

10% post fracture

POST LENGTH

60% loss of retention (16% non-restorable)

- Increasing post length increases retention far


greater than proportional increases in diameter

30% root fracture all non-restorable

(Nergiz et al. 2002)

72 prefabricated & cast post failures in a

follow-up study
(Torbjorner et al. 1995)

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FAILURE Root Fracture


FAILURE Coronal Root Fracture

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CERAMIC POSTS
Aluminum

Oxide

Zirconium

Dioxide

Ceramic Posts
COSMOPOST & CERAPOST
Tapered instead of parallel to conserve dentin
IPS Empress Ceramic Core
Radiopaque

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Ceramic Posts

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Fibre Posts

Esthetic
High

Modulus of Elasticity
(200 GPa same as metal)
Failure due to root fracture similar to metal
posts (Ferrari & Scotti, 2002)
Bonding requires Silanation
Problems with bonding to dentin after thermal
cycling and dynamic loading in vitro
(Kwiatowski & Geller, 1989)

Difficulty

removing without root perforation


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Industrial Composite
FILLER ~60% volume
- pre-tensed continuous fibers

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FIBRE POSTS
Epoxy

or polyester resin matrix


Glass, or Quartz Fibre (35-65%)
Barium Glass for Radiopacity
Carbon,

MATRIX ~40% volume


- UDMA epoxy resin
INTERFACE
- silane coupling agent
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COMPOSIPOST

Fibre Posts

Research Technique Dentaire


Marc Reynaurd & Bernard Duret
Reynaud & Duret, 1989

Industrial Composite

Weaker than metal posts


usually larger in diameter
Tapered shape to match canal
minimal dentin removal
Bond strengthen the root
lost over time and with load
Easy to remove
less risk of root perforation
No Corrosion
seal & strength

Composipost 1989
Aestheti-Post 1994
Light Post 2000

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1995: C-POST

Evolution of Fibre Posts


1997: AESTHETI-POST
1998: U.M. AESTHETI-PLUS
1999: AESTHETI-PLUS

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Post Rigidity
The more similarly dowels,
cements and restorative
materials behave in
comparison to dentin
the less force is concentrated
among the components and
the root during function.

2001

Pathways of the Pulp 8th Edition, 2010

D. T. LIGHT-POST

1999: LIGHT-POST

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Young s Modulus Of Elasticity

Young s Modulus of Elasticity


Elastic Modulus (GPa)

220

GPa

Ceramic

Ti

Gold

Stainless Steel & Ceramic (Zirconium Dioxide)

200
180
160
140

Titanium Alloy

120
100

Cast Gold

80

C-P
OS
THE
T
TI-P
LUS
LIGH
T-PO
ST

AES

60
40
20

Dentin Fiber

10

20

30

45

60

90

ANGLE (0)
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Protection of the Root

Bonding of Fibre Posts

STRESS TRANSFER TO TOOTH


- Finite Element Analysis

5 15 micron surface
roughness is ideal for
bonding
N/mm2

Bond strength of cement


to post is greater than the
post itself!

interface

Duret et al. 1996


Duret et al. 19961996.
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Radiographic Visibility

Radiopaque
fiber post with
resin cement

COSMOPOST

PARAPOST
WHITE

C - POST

Radiolucent
fiber post with
high-radiopacity
cement
Cast Post
ZnPO4

AESTHETI-PLUS

LIGHT-POST

Newtons

POST RETENTION

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Hedlund et al. 2002


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All fiber posts are NOT the same!

Glassix Post (White)

FibreKor Post (White)

DT LIGHT-POST (Trans)

ParaPost White

SnowPost (White)

Lucent Anchor (Trans)

FibreKor Post (White)

Glassix Post (White)

DT LIGHT-POST (Trans)

ParaPost White

SnowPost (White)

Lucent Anchor (Trans)

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PRODUCT

FIBER

% FIBER

FLEXURAL
MODULUS
(GPa)

TENSILE
STRENGTH
(MPa)

FLEXURAL
STRENGTH
(MPa)

ELASTIC
MODULUS
(GPa)

C-POST

Pre-tensed
Carbon

64%

130

2,260

1,900

17.8

AESTHETIPLUS

Pre-tensed
Quartz

62%

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2,200

1,400

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DT LIGHT-POST

Pre-tensed
Quartz

60%

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2,050

1,600

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FIBRE-KOR

Glass

42%

29.2

1,200

960

Not
Reported

PARAPOST
WHITE

Glass

42%

29.2

1,200

990

Not
Reported
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12-03-09

Fiber:Matrix ratio

Double Taper LIGHT-POST

5mm
10mm

DEJ

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Double Taper LIGHT-POST

Double Taper LIGHT-POST

Diameter

University

of Montreal
M-D and B-L radiographs of
967 extracted teeth
Endodontics: step-back,
crown-down & mechanical
rotary techniques
Measurements of the canal
after root canal treatments.

1.5mm

MAXILLARY

MANDIBULAR

Central Incisor

No. 3

No. 1

Lateral Incisor

No. 2

No. 1

No. 2 or 3

No. 2 or 3

No. 1

No. 2 or 3

Second Premolar
Molars

No. 2 or 3
Palatal: No. 2 or 3
Mesial: No. 1
Distal: No. 1

2.2mm

Taper

.06

.08

.10

.02

.02

.02

0.9mm

Double Taper LIGHT-POST

First Premolar

1.8mm

Taper

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Canine / Cuspid

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1.0mm

Diameter

1.2mm

3 post sizes that satisfy the Endodontist and the Prosthodontist


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Double Taper LIGHT-POST

No. 2 or 3
Distal: No. 2 or 3
Mesiobuccal: No. 1
Mesiolingual: No. 141

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12-03-09

MULTI-CENTER CLINICAL TRIALS


University

Teeth

Post

Root

Fracture

Fracture

Paris VII

404

Nice

137

Toulouse

150

Montreal

320

Modena

470

Sienna

1,314

Padua

450

Karolinska

236

TOTALS

3,477

SUCCESS
Retrospective study of 1,304 posts
- 249 Aestheti-Plus posts (quartz fibre)
- 215 Aestheti-Posts (quartz & carbon fibre)
- 840 Composiposts (carbon fibre)

97% success over 1- 6yrs


- 25 adhesive failures
- 16 periapical lesions
- NO post fractures, dislodgements or root fractures

NO ROOT FRACTURE!!!

Ferrari et al. 2000


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Quartz Fibre Posts

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RDT Double Taper Light-Post


ILLUSION X-RO

DT Light Post

Same sizes and properties as


original Double Taper
Light-Posts
Color-coded to match drills,
prevent mix-ups
Color disappears upon
placement.reappears
on cooling for easier
removal

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Double Taper LIGHT-POST


Diameter

1.25mm

1.5

ILLUSION X-RO

1.8

2.2

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Double Taper LIGHT-POST


ILLUSION X-RO
22OC

37OC

Now you see it

Taper

.04

.06

.08

.04

Taper

.02

.02

.02

.02

Now you don t


Diameter

0.8mm

0.9

1.0

1.2
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12-03-09

FIBRE POST PLACEMENT


Well fitting post allows for
thin cement layerless
polymerization shrinkage
and better force distribution
to the root (Ferrari & Scotti, 2002)

FIBRE POST BONDING

Significant differences between fiber post systems in


light transmission (Goracci et al. 2008)
Trim the Post with coarse
diamond or separating disc

Translucent post only able to transmit the light


intensity to the apex (Ferrari & Scotti, 2002)

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FIBRE POST BONDING

FIBRE POST BONDING

Light-Cure or Dual-Cure Bond

Dual-Cure Bond

Etch, Bond, Resin Cement...


Bisco Duo-Link
Self-Etching & Bonding
Bisco BisCem
Dual-Cure Resin bond
recommended due to limited
light transmission Bassi et al. 2009
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FIBRE POST BONDING

Root Dentin Bonding

Self-Etching & Bonding Bisco BisCem

Modulus of Elasticity close to dentin (Monobloc)


Dentin 14.2 Gpa
Fibre Post 1-2x
Stainless Steel 8-9x
Ceramic 15x
Cormier et al. 2001
Bonded posts strengthen the root initially (Saupe et al. 1996)
but exposure to functional stresses weakens bond
over time (Heydecke et al. 2001)

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Root Fracture

Root Dentin Bonding


Bonding is less predictable due to decreased

dentinal tubule density, altered collagen


expression (Mannocci et al. 2003)
No difference between microtensile bond
strength between translucent or opaque quartz
fibre posts or photo- or auto-polymerized
bonding systems (Mallmann et al. 2007)
Coronal

Middle

Apical

9.16 MPa

7.08 MPa

7.31 MPa

3-10%

for endodontically treated and


restored teeth (Walton et al. 1986)
Fibre Posts have fewer root fractures
than Metal or Ceramic Posts, but no
difference in force to failure when cast
restoration placed in vitro (Cormier et al. 2001)

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POST FRACTURE

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DTLP ILLUSION REMOVAL

INADEQUATE TOOTH STRUCTURE TO

RETAIN A CORE FOR A CROWN


Cool to identify the post

Fractured Carbon Fibre Post

Create a pilot hole

Drill out the post using a diamond burr following down its long axis

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SUCCESS

Root Fracture
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intact human incisors, sectioned,


endodontically treated root, post and core,
and crowned
- Cast Post & Core (Parapost plastic burnout post)
- Stainless Steel Parapost with composite core
- Carbon Fibre Post with composite core
- Ceramic Post with composite core

Randomized clinical trial comparing bonded


glass fibre and titanium posts with
composite resin cores found no difference
in success rates or complications
- 91 patients, 87 evaluated after 24-36 months
- 46 glass fibre & 45 titanium posts
- All posts 1.4mm diameter and 13mm long
- 2mm ferrule (13 crown lengthenings)

Ceramic

Posts were more likely to fail due to


post and root fractures
Hu et al. 2003
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96% success overall


- 1 caries
- 1 horizontal root fracture

Naumann et al. 2007


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12-03-09

New Fibre Post System


Questions???

What s Next ???


RDT

FiberconeTM
Auxiliary Post System for Cores
Quartz fibre, translucent, radiopaque

Fibre

Material
Matrix Material
Shape of Post (length & width)
Shape of Head
Sizes (posts, drills, reamers)
Color
Bond or Cement
Light Transmission
Packaging & Organization
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What s Next ???


RDT

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What s Next ???

FiberconeTM

RDT

FiberconeTM

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THANK YOU

Conclusions
Preserve coronal & radicular dentin
Preserve 4-5mm gutta percha apical seal
Avoid contamination of the gutta percha
Use posts only when necessary to retain a core
Post length & Crown retention/resistance form

are more important than actual post system


ferrule effect
Restore tooth ASAP (days not months)
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Any Questions?
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12-03-09

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