Restoration of

Endodontically
Treated Teeth
Post and Core System
 Characteristics of endodontically treated teeth
1. Tooth structure loss by:
i. Caries, trauma, erosion, abrasion, attrition.

ii. Previous restorations and recurrent caries under

restorations.

iii. Endodontic treatment; due to removal of coronal and

intraradicular Dentine during access and root canal
preparation.
 1. Micro cracks in remaining tooth
structure produced by endodontic
procedures.

2. Weakened collagen intermolecular

cross-links of Dentine  lower shear
strength.

3. Dehydration; non-vital teeth have

less moisture content than vital teeth.

4. Esthetics; biochemically altered

Dentine modifies light refraction
through the tooth and modifies its
appearance
 The combined result of these
changes are: increased fracture
susceptibility and decreased
translucency.
 Treatment planning for non-vital teeth
1. Pretreatment 2. Treatment plan:
Evaluation: i. Post
i. Quality of the endodontic ii. Core
treatment iii. Definitive restoration
ii. Periodontal condition
iii. Restorative evaluation
i. Strategic importance
ii. Anatomic position of
the tooth
iii. The amount of
remaining coronal
tooth structure
iv. The functional load
on the tooth
iv. esthetic evaluation
 Treatment planning for non-vital teeth
1. Pretreatment Evaluation:
i. Quality of the endodontic treatment:

i. Periodontal
condition:
iii. Restorative evaluation:
a. Strategic importance:
• does the final restoration depends on this tooth ? Are the
adjacent teeth reliable? What about an implant ?
iv. Anatomic position of the tooth:
Anterior teeth:
• They receive mainly angular forces  reinforcement
effect of posts is doubtful.
• If the tooth is intact except for the endodontic access opening
 etched resin in the access is sufficient.

• A post and core is only indicated when the tooth is weakened

by the presence of large or multiple coronal restorations or
they require form or/and color changes that cannot be affected
by bleaching, resin bonding or laminate veneers.

• Mandibular incisors and maxillary lateral incisors  usually

require a post.
• Posterior teeth:

• They receive mainly vertical forces.

• When there is sufficient tooth structure to retain a core

and crown  posts are not needed.

• Teeth which have interdigitation with opposing teeth

 full coverage crowns or onlays should be used as
occlusal forces push the cusps apart.

• Maxillary premolars are subjected to angular and

vertical forces  if the clinical crown length > its
cervical width a post may be indicated.
 c. The amount of remaining coronal tooth structure
If the coronal structures are largely intact and
loading is favorable (access cavity)
conservative treatment 
with coronal restorations without post. 

If a substantial amount of coronal structure is

missing (one marginal ridge at least)
 post, core, and definitive restoration.
D. The functional load on the tooth:
The post, core, and crown system is indicated,
when more extensive protective and
retentive features are required in the
restoration:

1. Bruxism and heavy occlusion.

2. Abutment teeth for long-span fixed bridges.

3. Abutment teeth for free end

removable partial denture.
iv. esthetic evaluation:

• Esthetic zone (Anterior teeth, premolars, and

often 1st molar) requires:

1) Careful selection of restorative materials.

2) Careful handling of the tissues.

3) Timely endodontic intervention to prevent

darkening of the root as it looses vitality.

What are the factors
to be considered while
planning the final
restoration?
 FACTORS

 Amount of remaining sound tooth structure

 Occlusal function
 Opposing dentition
 Position of the tooth in the arch
 Length, width and curvature of the roots

Endodontics : Restoring of Endodontically Treated Teeth

American Association of Endodontics.1995 Dec Publication
 Classification Based on the
remaining tooth structure
Classification Description
Class I 4 walls
Class II 3 walls
Class III 2 walls
Class IV 1 wall
Class V No wall

Restoring endodontically treated teeth with posts and cores—a review

Ingrid peroz et al.Quintessence International no.9 volume 36 oct 2005.
 ANTERIOR TEETH
 Anterior teeth with
minimal loss of tooth
structure can be
restored
conservatively with a
bonded restoration in
the access opening
 ANTERIOR TEETH
 A post is of little or no benefit in a
structurally sound anterior tooth
 Increases the chances of a failure
 ANTERIOR TEETH
 In cases of extensive loss of external tooth
structure, a post is usually required for anterior
teeth, due to the predominantly shearing forces
present and the narrow tooth dimensions.
 Extra-coronal crown preparation combined with
endodontic access preparation significantly
weakens the cervical area of anterior teeth.

Post Placement and Restoration of Endodontically Treated Teeth: A

Literature Review. Richard S. Schwartz, et al. Journal of
Endodontics:VOL. 30, NO. 5, MAY 2004
Posterior teeth
Considerations for posterior teeth
 Endodontically treated posterior teeth are subject to
greater loading than anterior teeth, because of their
position closer to the insertion of the masticatory
muscles. This, combined with their morphologic
characteristics, makes them more susceptible to
fracture.
Treatment plan:
1-Post
2-Core
3-Definitive restoration
 POSTS
 Role of posts
 Indications
 Post selection:Factors to be considered
 Ferrule effect
 Types
 Procedure
 The Role of Posts in the Restoration
of Endodontically Treated Teeth
 The primary purpose for a post is to retain a
core that can be used to support the final
restoration.
 Posts do not reinforce endodontically treated
teeth, and a post is not necessary when
substantial tooth structure is present after a
tooth has been prepared.

W. Cheung, “A review of the management of endodontically treated teeth:

post, core and the final restoration,” Journal of the American Dental
Association, vol. 136, no. 5, pp. 611–619, 2005.
 INDICATIONS
Post placement is indicated if both of the
following clinical conditions exist:
 The remaining coronal tooth structure is
inadequate for the retention of a restoration.
 When there is sufficient root length to
accommodate the post while maintaining an
adequate apical seal.

Stockton LW.Factors affecting retention of post systems:

A literature review. J Prosthet Dent 1999;81:380–385.
 FACTORS TO CONSIDER

Post length
Post diameter
Post design

Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet

 Post length
Guidelines:
1. The post should more than the incisocervical
or occlusocervical dimension of the crown.
2. The post should be longer than the crown.
3. The post should be 2:3 or at minimum 1:1
ratio (crown\root ratio).
4. The post should end halfway between the
crestal bone and the root apex.

Stockton LW.Factors affecting retention of post systems:A literature review. J Prosthet

Dent 1999;81:380–385.
Ideal tooth
preparation
for post
placement
 Post Size and Length

Post length is unique and individualized for each

case. The clinician should have a thorough
The effect
knowledge of the
of root embedded before
morphology depth of posts aonpost.
placing
retentive capacity has been shown to
The longer the post, the greater the retention. Abe
guideline of one half tosignificant
three quarters of the root
length is often followed but may not be reasonable
for extremely long, short, narrow, or curved roots

Retention of endodontic dowels: effects of cement, dowel length, diameter, and

design. Standlee JP, Caputo AA, Hanson EC: J Prosthet Dent 39:401, 1998.
 Post diameter
 The diameter of the post is dictated by
the root canal anatomy.
 A minimal dentin thickness of 1 mm around
the post should be provided.

Lloyd PM, Palik JF. The philosophies of dowel diameter preparation: A

literature review. J Prosthet Dent 1993;69:32–36.
 Post design
 Posts can be serrated,
smooth, roughened or
threaded.
 Parallel, serrated posts
are cemented into the
canal passively. They are
retentive and produce less
stress in the root dentine
than threaded systems

Post Placement and Restoration of Endodontically Treated Teeth: A Literature Review.

Richard S. Schwartz, et al. Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
 Ferrule Effect
 The ferrule is the circumferential ring of
sound tooth structure that is enveloped by
the cervical portion of the crown
restoration. A minimum sound dentine
height of 1.5-2 mm is required between the
core and crown margins.

Sorensen JA and Engelman MJ. Ferrule design and fracture resistance of

endodontically treated teeth. J Prosthet Dent 1999;63:529-536.
 Importance of ferrule
The ferrule provides bracing or casing action
to protect the integrity of the root.
 CHARACTERISTICS OF AN
IDEAL POST:
 Minimum preparation.
 Resistance to fatigue.
 Elastic modulus similar to dentin.
 Non corrosive.
 Retentive (post & Head).
 Easy to adjust and fit.
 Radiopaque.
 Adequate material
 Easy Removal

Factors determining post selection: A literature Review.

Fernandes A., Shetty Sh., Coutinho I.-
J Prosth. Dent. Dec. 2003.
 TYPES OF POSTS
METALLIC NON-METALLIC

 Stainless Steel  Carbon Fibre

 Titanium  Ceramic
 Titanium Alloy  Glass-fibre
 Gold-Plated reinforced
brass  Composite
Fundamental of fixed prosthodontics 3 editions
Herbert T. shillingburg
Page no 345
Types of Posts
Prefabricated posts
 Custom made posts
 Direct Technique
 Indirect Technique

Wax pattern before casting.

 Custom cast post and core
Advantages: Disadvantages:
 Preservation of maximum  Less stiff than
tooth structure wrought
 Provision of anti-rotational  Time consuming,
properties complex procedure
 Core retention
Recommended Use:
 Less chances of vertical
Elliptical canals
fractures during preparation Flared canals
 High strength
 Prefabricated Tapered Post
Advantages: Disadvantages:
 Conserves tooth  Low retention
structure  Longitudinal
 High strength and splitting of
Recommended Use:
remaining root
stiffness Small circular canals

Post placement and restoration of endodontically treated teeth: A

literature review.
Schwartz. R, Robbins. J.
J Endodon 2004, 30: 289-301.
 Prefabricated Parallel - Sided
Smooth Post
Advantages: Disadvantages:
 Excellent clinical  Precious material
retention post expensive
 Minimal stress  Corrosion of
production within stainless-steel
root  Less conservative of
 Ease of placement tooth structure
 Superior rating
Color Atlas of Endodontics. , 2nd edition
William T.Johnson, page no 133-134.
 Prefabricated Threaded Posts

Advantages: Disadvantages:
 High retention  Stresses generated in
canal may lead to
fracture
Recommended Use:  Does not conserve
Only when maximum coronal and radicular
retention is essential
tooth structure

Color Atlas of Endodontics. , 2nd edition

William T.Johnson, page no, 133-134.
 Carbon Fiber Post
Advantages: Disadvantages:
 Dentin bonding  Low strength
 Easy removal (compared to metal)
 Lack of radiopacity
Recommended Use:
Can be used in posteriors  Carbon color
with moderate loss of presents an esthetic
coronal structure problem

Post Placement and Restoration of Endodontically Treated Teeth: A

Literature Review. Richard S. Schwartz, et al.
Journal of Endodontics:VOL. 30, NO. 5, MAY 2004
 Fiber Reinforced Post
Advantages: Disadvantages:
 Esthetic  Low strength
 High failure rate
Recommended Use:
Should not be used where remaining
tooth structure is less than ideal or where
high occlusal forces are present.

Aesthetic posts and cores for metal free restoration of

endodontically treated teeth. Adriana Quintas, Jose Dinato. Pract
Periodont Aesthet Dent; 12(9): 875-884
 Zirconia Ceramic Post
Advantages: Disadvantages:
 Esthetics  Expensive
 High stiffness  Uncertain clinical
 High modulus of performances
elasticity
Recommended Use:
High esthetic demands
 Procedure

Textbook of Endodontology 2 editions Preben Hørsted-Bindslev Page no 326

A review of the studies done
on the various post systems
suggests that the fiber
posts are the most reliable!!!
 Fiber posts show more homogeneous stress distribution than metallic posts
Natercia R Silva, Carolina G Castro, Paulo CF
Santos-Filho.
Indian journal of dental research 2009 vol 20
Fractures allow repair
Akkayan B, Gulmez T.
Good strength J Prosthet Dent. 2002;87:431–437

Readily retrievable Cormier CJ, Burns DR, Moon P.

J Prosthodont. 2001;10:26–36
Better than cast post system in the long term
Ferrari M, Vichi A, Garcia-Godoy F.
Am J Dent. 2000;13:15B–18B

More favourable
Fokkinga WA, Kreulen CM, Vallittu PK,
Creugers NH.
Int J Prosthodont. 2004;17(4):476–482
 CORES
 Indications
 Principles
 Types of core build up
 Procedure
 INDICATIONS
Core restorations are indicated if any of the
following clinical conditions exist:
 The replacement of missing coronal tooth
structure is necessary.
 When the enhanced retention and resistance
to displacement of the final restoration is
necessary.

Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburg Page no 367

 MATERIALS USED FOR CORE
BUILD UP
DIRECT PLACEMENT:
1.Composite resin
2.Amalgam
3.Glass ionomer resin
INDIRECT PLACEMENT:
Casting

Fundamental of fixed prosthodontics 3 editions Herbert T. shillingburg

Page no 369
 Composite resin core
Advantages: Disadvantages:
 Good compressive  Polymerization
strength shrinkage
 Easy to manipulate  Poor dimensional
 Rapid stability
polymerization Recommended Use:
 Dentin bonding Excellent build-up material
for posterior and anterior
teeth if isolation assured
 Amalgam core
Advantages: Disadvantages:
 Reduced marginal  Mercury sensitivity
leakage  Low tensile strength
 Better dimensional  Corrosion with base
stability metal
 Better compressive Recommended Use:
strength Molars with adequate
 Better modulus of coronal tooth
elasticity structure
 Glass Ionomer resin core
Advantages:
 Anticariogenic
 Adhesive
 Easy to manipulate
Recommended Use:
Teeth with minimum
tooth structure missing
Disadvantages:
 Low resistance to
fracture
 Low retention to
preformed post
 Sensitive to moisture
So which is the best
material for core
buildup???
  The modulus of elasticity of amalgam is
significantly higher than all other material
tested and is closer to that of dentin
 Prepared core build-ups in a hybrid
composite material provided the highest
fracture resistance

Fracture resistance of five pinretained core buildup materials on teeth with and
without extracoronal preparation.
Burke, FJT, Shaglouf, AG, Combe, EC, Wilson, NHF.
Operative Dentistry 2000; 25: 388-394.
  This study showed that the tensile and
flexural strengths of composite are
significantly higher than that of amalgam
and glass ionomer.

Kovarik, Robert E., Breeding, Larry C., Caughman, W. Franklin. Fatigue

life of three core materials under simulated chewing conditions.
The Journal of Prosthetic Dentistry Oct 1992; 68(4): 584-589.
  Tensile strength and modulus of elasticity
of glass ionomer cements are significantly
Based
lower than on the
dentin andabove
amalgamstated
evidence,
 Glass ionomerscomposite seems
are relatively to be
slow-setting
thetheir
and bestearly
choice as a core
resistance build up
to moisture is poor
material.

Mechanical properties of direct core buildup materials.

Combe, E.C., Shaglouf, A., Watts, D.C., Wilson, N.H.F.
Dental Materials 1999; 15: 158-165.
Conclusion
 Anterior Tooth

Class I - III Class V

Class IV

Complete
Complete Coverage Complete Coverage
Coverage is
is required is required
not required

Prefabricated fiber post with

Conservative Trt
composite core
Resin composite
full ceramic crown
 Posterior Tooth

Class I-III Class V

Class IV

Pre-fabricated fiber
post
Conservative Trt
Composite Core Composite Core
Onlay
Fiber post Metal Ceramic
Metal Ceramic crown
Crown
copyright cmassengale