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) 7
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
9
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
10
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
11
12
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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)
Length Post & Core Rigidity Anti-Rotational Features Crown Ferrule Isador et al. 1999
13
RETENTION & RETRIEVABILITY
14
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)
15
16
FAILURE Root Fracture
FAILURE Coronal Root Fracture
17
18
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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
19
Ceramic Posts
20
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)
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
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
27
28
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) 29
30
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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. 31
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
32
Hedlund et al. 2002
33
34
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)
35
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%
44
2,200
1,400
15
DT LIGHT-POST
Pre-tensed Quartz
60%
46
2,050
1,600
15
FIBRE-KOR
Glass
42%
29.2
1,200
960
Not Reported
PARAPOST WHITE
Glass
42%
29.2
1,200
990
Not Reported 36
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Fiber:Matrix ratio
Double Taper LIGHT-POST
5mm 10mm
DEJ
37
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
39
Canine / Cuspid
38
1.0mm
Diameter
1.2mm
3 post sizes that satisfy the Endodontist and the Prosthodontist
40
Double Taper LIGHT-POST
No. 2 or 3 Distal: No. 2 or 3 Mesiobuccal: No. 1 Mesiolingual: No. 141
- 25 adhesive failures - 16 periapical lesions - NO post fractures, dislodgements or root fractures
NO ROOT FRACTURE!!!
Ferrari et al. 2000
43
Quartz Fibre Posts
44
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
45
Double Taper LIGHT-POST
Diameter
1.25mm
1.5
ILLUSION X-RO
1.8
2.2
46
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 47
48
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)
49
50
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 51
52
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)
53
54
12-03-09
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)
55
POST FRACTURE
56
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
57
58
SUCCESS
Root Fracture 40
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 59
96% success overall
- 1 caries - 1 horizontal root fracture
Naumann et al. 2007
60
10
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 61
What s Next ???
RDT
62
What s Next ???
FiberconeTM
RDT
FiberconeTM
63
64
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) 65
