1 As early as 1728, Pierre Fauchard described the use of

tenons, which were metal posts screwed into the roots

of teeth to retain bridges
In the 1700s Fauchard inserted wooden dowels in canals
of teeth
to aid in crown retention (Fauchard 1746). Over time the
wood would expand in the moist environment to enhance
retention of the dowel unit, unfortunately, the root would
often fracture vertically (Shillingburg 1997). In the 1700s
Fauchard inserted wooden dowels in canals of teeth to aid
in crown retention (Fauchard 1746). Over time the wood
would expand in the moist environment to enhance
retention of the dowel unit, unfortunately, the root would
often fracture vertically (Shillingburg 1997).
1. The use of posts in the root canal space to retain an
overlaying restoration has a history of at least 300
years (Ring 1985).
2. In 1871 Harris Chapin recommended a post or a
pivot to retain an artificial crown in a root with an
extirpated pulp (Harris C 1871). Additional efforts to
develop crowns retained with posts or dowels in the
1800s were limited by the failure of the endodontic
therapy of that era

The Richmond crown was introduced in 1878 and

incorporated a threaded tube in the canal with a screwretained crown (Richmond 1878). The glossary of
prosthodontic terms 8th edition
defined the Richmond crown as an artificial crown
consisting of a metal base that fits the prepared abutment
of the natural tooth and carries a post or pivot for
insertion into the endodonticaly treated root canal: a
porcelain facing reinforces the metal backing
The Richmond crown was later modified to eliminate the
threaded tube
and was redesigned as a 1-piece dowel and crown
(Hampson 1958, Demas 1957).Coronal coverage has
always been considered a very important factor for
preventing root fractures in endodontically treated teeth
(Frank 1959). Many years ago it was suggested (Rosen
1961) that a sub-gingival collar might provide an extracoronal bracing able to prevent fractures of the root. The
term ferrule effect was used for the first time in 1987 by
Eissman and Radke and it indicates a 360-degree ring of
cast metal that embraces the tooth.
In 1911 the Davis crown was introduced; a dental
restoration supported by a dowel in root canal over which

was cemented a porcelain tube tooth in direct contact with

the root face of the tooth (Davis
1916). A later modification of the Davis crown involved a
gold casting that improved the fit between the root and
artificial tooth
An alternative method using prefabricated metal posts and
composite resin or amalgam as a core material was
introduced around the 1970s and has been used ever since
on a large scale (Baraban 1972, Spalten 1971).
This assumption is based on the research of Helfer et al.
(1972) who reported that there was a premature loss of the
fluid supplied by vital pulp and there was approximately
10% less collagen-bound water in ETT (Helfer et al.,
1972)
Trope et al. evaluated fracture resistance of restored
endodontically treated teeth; they
found that preparation of post space significantly
weakened endodontically treated teeth and that
a post did not significantly strengthened treated teeth
(Trope 1985).
Reeh et al. (1989) compared the effect of root canal
therapy procedures and intra-coronal restorative
preparation on tooth stiffness. Root canal procedures

reduced tooth stiffness by only 5%, attributed primarily to

the access opening, while restorative procedures resulted
in more appreciable loss of tooth stiffness.
The effect of a metal collar on stress distribution with cast
post and cores was studied by using three-dimensional
photoelastic models of maxillary canine teeth of average
dimensions. Standardized parallel post and cores
cemented into the models were used, with half of the
samples incorporating a 1.5 mm metal collar, and a 400
gm load was applied to the cingulum of the cores.
Stresses were then calculated and, on a point by point
basis, a better distribution was found in the collared
specimens (Loney et al 1990
Custom-fabricated cast post and core has been used for
decades as a foundation to support the final restoration in
ETT (Perel & Muroff, 1972; Shillingburg & Kessler,
1982). Guidelines have been established for fabrication of
cast post and cores, and documentation that favors cast
posts rather than prefabricated posts has frequently
appeared in the literature (Shillingburg et al., 1970;
Dykema et al., 1986; Bergman et al., 1989; Rosenstiel et
al., 2006).
With the introduction of fiber posts (Duret et al., 1990a;
1990b, 1992), a new trend has been established, in the

restoration of the endodontically-treated teeth. Fiber posts

can be considered as composite reinforced materials.
Cast post and cores are appropriate for almost all cases,
but especially indicated for elliptical or flared canals,
teeth with little or no remaining coronal structure and to
compensate for disparity between the angulations of the
root and the planned crown (Sokol, 1984; Bergman et al.,
1989; Loney et al., 1990; Morgano & Milot, 1993;
Stewardson, 2001; Rosenstiel et al., 2006).
16
Specifically, the loss of marginal ridges in MOD cavity
preparation produced the greatest reduction in tooth
stiffness by more than 60%.
Radke and Eismann suggested in 1991 that one function
of the post is to provide reinforcement of the tooth (Cohen
1991).
One-piece dowel restorations also presented problems
when the crown or fixed
partial denture required removal and replacement. These
difficulties led to the development of a
post-and-core restoration as a separate entity with an
artificial crown cemented over core and

remaining tooth structure (Morgano 1999).

Teeth that were commonly extracted without hesitation
were
successfully treated with predictable endodontic therapy,
and a satisfactory restorative solution
was necessary, especially for teeth with severe damage.
Cast post and cores became routine
methods for restoration of endodontically treated teeth
(Morgano 1999)
The Glossary of Prosthodontic Terms describes a post as
usually being made of metal that is fitted into a prepared
root canal of a natural tooth. When combined with an
artificial crown or core, it provides retention and
resistance for the restoration (Academy of
Prosthodontics, 2005).
To manufacture fiber-reinforced post, the first step is to
produce cylindrical barrels and then these barrels are
machined into different shape and diameter. Pultrusion is
the name for this process, frequently it is a continuous and
semi-automated process. Resin-impregnated fibers are
pulled through a series of forming dies. The final die is
heated to cure the resin, thereby producing a rigid
composite section. The profile is determined by the die
cross-section which could be round, rectangular, square or

a variety of other shapes. The section produced can either

be cut into dicrete lengths after the puller system or
wound onto a drum. The speed of travel through the die is
determined by the viscosity, thickness and curing of the
resin. The process uses a hardened (hard-chromed) steel
die and a pultrusion machine (Fig 1).
16
Fig 1. The pultrusion process. The benefits of this
process are increased strength/stiffness of the final
product, especially if compared to the two single
components alone. High pressure and temperatures
densify the composite, further impregnating the fibers and
eliminating voids. This process offers a high fiber to resin
ratio, which translates directly into superior strength
characteristics of the fiber-reinforced material. Any
variation in pressure and temperature values during the
process may result in variation of the mechanical
properties of the material. Finally, a post is fabricated that
is composed of fibers (carbon i.e., 66% in weight,
diameter of the single fiber around 10-15 microns) and
filler (i.e. epoxy resin, 33% in weight). Fibers can be pretreated with a silane-coupling agent to obtain a chemical
bond between the fibres and the resin. This applies to
glass, quartz and even carbon fibers. As a matter of fact
fibers must be treated just after their manufacturing.

Otherwise it is impossible to work with because fibers

will be in all direction, not assembled. They will stick and
will not have enough rigidity for handling (just like a
roving of cotton). And one the goal of the treatment is to
allow fibers to be handled, stored in roving. The addition
of silane during the pultrusion process gives more
stability to the system, and is the key factor for success in
manufacturing. The importance of this topic will be
discussed in chapter 4. In general, the addition of silanecoated glass fiber to BIS-GMA resin increases the elastic
modulus, tensile and compressive strengths compared
with nontreated fibers. The use of carbon fibers for the
reinforcement of polymethylmethacrylate used for the
construction of denture bases was first suggested by
Schreiber in 1971. When a fiber post is manufactured, the
composite
17
that is formed is anisotropic: as a consequence mechanical
properties differ according to the direction of
measurement.
The Composipost (RTD, St Egrve, France) is the most
studied carbon-fiber post. It was described by its
inventors as a post fabricated from continuous,
unidirectional high performance, pyrolytic carbon fibers,

8 m in diameter uniformly embedded in an epoxy-resin

matrix (Duret et al., 1990a, 1990b)
The use of glass and quartz fibers was initially proposed
as an alternative to the dark colour of carbon posts. Even
though a ceramo-metal crown, and often even a full
ceramic crown is able to mask the dark colour of the post
underlying the restoration (Vichi et al., 2000), esthetic
posts eventually gained popularity (Ferrari et al., 2001).
translucent fiber posts are now available to be used in
combination with a dual curing resin cement and to take
advantage of light passing through the post for
polymerization
(Ferrari et al., 2000) In a study comparing cast post and
cores and carbon fiber posts, 200 patients were examined.
The failure rate for cast post and cores (Group 1, high
modulus restorations in terms of modulus of elasticity)
and fiber posts (Group 2, low modulus restorations) was
totally different. Group 1 had 84% clinical success, 2%
excluded for non-compliance, and 9% root fracture (no
need to inderline), 2% dislodgement of crown, 3%
endodontic failures. Conversely Group 2 had 95% clinical
success, 3% excluded for non-compliance, 2% endodontic
failures. The difference between the two groups was
highly statistically significant. For this reason, clinical
acceptance of fiber posts is now higher than it was before.

The advantage of having no root fracture is very

important
When fiber posts and a core and metal posts and a core
were compared, it became more and more obvious that
the first ones functioned more satisfactorily. As far as the
mechanism of failure is concerned, metallic posts on
failure tend to produce an irreversible root fracture.
Conversely, in the presence of a fiber post, root fracture
that occurs is usually located more coronally and is more
easily retreatable (Reagan et al., 1999, Ukon et al., 2000,
Cornier et al., 2001
This type of failure may be due to the wider amount of
tooth structure must be sacrificed when a metallic post is
placed (Stankiewicz et al., 2002). Two recent papers
underlined the concept mentioned above: even if a crown
is made, when a failure occurs, favorable fractures are
seen in teeth restored with fiber posts and resin cores,
whereas unfavorable fractures or failures are usually
encountered with the use of a metal post, or a fiber post of
bad quality (Heydecke et al., 2002, Akkayan et al., 2002).