Restoration of

Endodontically Treated
Tooth by post and core
 Methods for Restoration of an
Endodontically Treated Tooth
• Simple filling (amalgam, composite)
• MOD restoration
• Amalgam nayyar (amalgam pins)
• Extra coronal crown restoration
• Post and core
 Coronal seal vs apical seal
• Which is more important for long term
prognosis of teeth following root canal
therapy??
 Coronal seal vs apical seal
• Ray and Trope evaluated the relationship
between the quality of the coronal restoration
and the quality of the root canal filling by
examining the radiographs of endodontically
treated teeth.
• They observed that a combination of good
restorations and good endodontic treatments
resulted in absence of periapical Inflammation
in 91.4% of the teeth
• whereas poor restorations and poor endodontic
treatments resulted in the absence of
periradicular inflammation in only 18.1% of
the examined
• poor endodontic treatmens were followed by
good permanent restorations, that appeared
radiographically sealed, success rate 67.6%.
• They concluded that apical periodontal health
depended significantly more on the coronal
restoration than on the technical quality of the
endodontic treatment.

International Endodontic Journal,1995

Salivary microleakage is considered to be a
major cause of endodontic failure

Contamination of the root-canal system with

bacteria must be prevented during and after
endodontic treatment.
 salivary microleakage after
endodontic treatment:
• during post space preparation
• after post cementation
• through temporary fillings
• through leaking margins of permanent
restorations .
Why endodontic teeth break??
 • Remaining tooth structure is key
to tooth strength

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• A direct relationship exists between the amount
of remaining tooth structure and the ability to
resist occlusal forces
Post & Core

POST

CORE
 Definitions

• Dowel (Post):
The dowel is a metal post or other rigid
restorative material placed in the
radicular portion of a non vital tooth.
• Core:
Refers to properly shaped and well
substructure, which replaces missing coronal
structure and retains the final restoration.
 Indication

1. Crown badly destructed endodontically treated (ET)

anterior & posterior.
2. bridge, with abutment ET tooth and Crown badly
destructed
3. ET teeth with biological sound root.
4. ET teeth with perfect apical(obturation) seal.
5. ET teeth with long, thick, strong root.
6. ET teeth without any periapical pathosis.
7. ET teeth with healthy Periodontal ligament and alveolar
support.
 Contra- indication

1. Improper root canal filling.

2. Presence periapical pathosis.
3. Weak, thin, curved, very narrow root.
4. Heavy, edge to edge bite.
5. Patient with diseased periodontal ligament support.
6. Patient with parafuctional habits.
 Treatment Plan
Evaluation of root filled tooth:-
By studying 2 aspects:-
(1) Clinical evaluation
(2) Radiographic evaluation
 Treatment Plan
Evaluation of root filled tooth:-
1. Clinical evaluation of the quality of RCT
• Good coronal seal
• No sensitivity to pressure
• No exudate
• No fistula
• No apical sensitivity
• No active inflammation
• No mobility
Evaluation of root filled tooth:-
Radiographic evaluation
Periapical radiographs to check for
(1)Evidence of radicular and periradicular
pathology such as:
- infection,?
- resorption?
- root fracture?
- perforations?
 Treatment Plan
Evaluation of root filled tooth:-
Radiographic evaluation
Periapical radiographs to check for
(2) The quality of existing root canal fillings
- under-filled?
- over-filled?
- poorly compacted with voids present?
 Treatment Plan

• Inadequate RCT teeth should be retreated

• Doubtful RCT teeth should be observed for

several months
Restorations for anterior teeth
Every endontically treated tooth
indicated for crown?
Crowns are indicated only on endodontically
treated anterior teeth when they are structurally
weakened by the presence of large and/or multiple
coronal restorations

or they require significant form/color changes that

cannot be effected by bleaching, resin bonding, or
porcelain laminate veneers
Anterior teeth
 Minimal Damage
Minimal damage with Restored with simple
favorable occlusion composite fillings
 Minimal Damage

• In anterior teeth that are

minimally to moderately
restored (less than 50%) of tooth
structure is lost, then a direct
composite restoration will be the
restoration of choice.

the GP, which should ideally be

cut back to osseous level
 Minimal Damage
• Placing composite
below the CEJ has 2
functions:

1. Good coronal seal

2. Reduces fracture
susceptibility of tooth
 Moderate- Sever Damage
• If ≥50% of the tooth structure is missing then
an extra- coronal restoration is indicated.
 Û

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Posterior Teeth
• posterior teeth with large access cavities
following extensive carious lesions carry
greater occlusal loads and there fore require
protection against possible fracture
 Minimal Damage
Small access, no/ minimal MOD onlay to protect
proximal involvement remaining tooth structure
 Adequate remaining coronal tooth structure
provide cuspal protection

Howard W.- Atlas Of Operative Dentistry. C.V. Mosby Co. 1973

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 Moderate- Severe Damage
Premolars: Post(if needed) and
Loss of significant central + crown
peripheral structure Molars: amalgam foundations+
Crown
 Moderate- Severe Damage
• Teeth 16, 15 and 14 have been root filled, no post has been placed and the pulp
chambers together with the dentine bonding agent have been used to retain the
composite cores - this called Nayyar core.
 crown
Total loss of Supra- Gingival
Molar: Post& core+
Structure
Crown
Total coronal destruction
 post
• When and why??
• the use of posts does not reinforce
endodontically treated teeth

• some reports even show that teeth which were

restored without a post and core are less
susceptible to fracture than teeth with post and
core

A. Sm idt and E .et al, Quintessence Inernational, 2003

• The main purpose of a post is to retain a core
buildup in a tooth with extensive loss of
coronal tooth structure
 CERVICAL FERRULE
A ferrule is a metal band or ring used to fit the root or crown of a tooth.

• Increased fracture resistance

• Antirotational
 ferrule
• The band of extra-
coronal material
(usually metal or metal
ceramic) that
encompasses this tooth
tissue is termed the
ferrule
• this extension of dentine, when encircled by a
crown, provides a protective effect by reducing
stresses within a tooth; the ‘ferrule effect’

• Charles J G, Joseph Y, Kan K. ENDODONTICS. 6th ed. 2008:1431-73.

• an adequate ferrule is considered to need a
minimum of 2 mm of vertical height and 1 mm
of dentin thickness
Ferrule effect
No ferrule effect
With Ferrule Without Ferrule
• 2 mm of tooth tissue coronal
to the finish line of the
crown preparation
significantly improves the
fracture resistance of the
tooth.
• the amount of tooth structure engaged by the
overlying crown appears to be more important
than the length of the post in increasing a
tooth’s resistance to fracture

• Stankiewicz N, Wilson P. The ferrule effect. Dent Update. 2008

Insufficient coronal tooth tissue for
a ferrule
 The purpose of a post and core

1. Replacement of lost coronal tooth structure

required for the retention of a restoration.

2. Protection of remaining tooth structure by

distributing the stress to the root along the
post.( by having ferrule effect)
• The ferrule reduced vertical root fracture by
one third , and when failure occurred, it is
usually in the form of horizontal root fracture

• K. M. etal“Coronal leakage of m ixed anaerobic b acter i a a fter obtur a

tionOral Su rge r y, Oral Me dic i ne, OralPa tholog y, Oral Radiolog y, and
Endodont 1997.
Part 2
 What are the treatment options for a tooth
with insufficient coronal tooth tissue for a
ferrule?

• Orthodontically extrude the root

• Crown lengthen
• Extract and replace with a fixed or removable
prosthesis.
 Crown Lengthening
(To expose sound tooth structure)
• Indications:
• -Subgingival location of caries lesions
• -Subgingival location of fracture lines
• -Inaccessibility of subgingival margins of
failing restorations
• -Inaccessibility of subgingival prepared
tooth structure for proper impressions
 Crown Lengthening
(To expose sound tooth structure)
 Ferrule Effect

• Sorensen e

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Posterior teeth
Crown lengthening Orthodontic extrusion
• Post length
 4-5 mm of apical seal of gutta percha

2/3 length of the root

or
Equal to length of clinical core
or
4 mm apical to the bone crest
Or
Which ever is greater

2022-10-31 64
 Post diameter
• narrowest diameter for fabrication of a certain
post length (the conservative).
• a space with a diameter that does not exceed
one-third the root diameter
(the proportional).
• The third group advised leaving at least 1 mm
of sound dentin surrounding the entire post
(the preservative)
 Philosophy in dowel preparation :

Conservative Preservative Proportional

1mm 1mm
1/3 1/3
1/3

Û Lloyd M. P., Palik F. J.- The philosophies of dowel diameter preparation: A literature review.
Û J. Prosth. Dent., 1993; 69: 1-32.
2022-10-31 70
• Excessively widened post spaces may lead to
root fracture.
Û Shillingburg H. T., Kessler C. J.- Restoration Of Endodontically Treated Teeth. Quint. Books. 1982
2022-10-31 72
 Posts are divided according to
their retention form into 2 main
types
(a) Active, derive their primary retention
directly from the root dentine by the use of
threads.
2. Self-threading
2. Pretapped systems
(b) Passive, posts gain retention by passively
seating close to the post hole walls, and rely on
the luting cement for their retention.
Types of Post Retained Crown
 according to its general shape into:-
(a) Parallel sided
(b) Tapered sided
active posts are more retentive than passive
posts of a similar configuration.

parallel-sided posts are more retentive than

tapered posts.
 POST SHAPE:
• Tapered Conical- Conservative preparation because of the natural
shape of the canal. Less retentive. Wedging effect

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Disadvantage: wedging effect may cause root
fracture
 POST SHAPE:
• Tapered Conical- Conservative preparation because of the natural
shape of the canal. Less retentive.
• Parallel - Extensive preparation, specially at the apical area, better
retention. distribute stresses better than tapered posts which have
Wedging effect. higher stresses at the apex

2022-10-31 80
 POST SHAPE:
• Conical- Conservative preparation because of the natural shape of
the canal. Less retentive.
• Parallel - Extensive preparation, especially at the apical area,
better retention.
• Hybrids- More conservative in the apical area with good
retention.

2022-10-31 81
Classification

According to material

All metallic

Non metallic
- carbon fiber post Combination
- Glass fiber post - metal+ceramic
- Zirconium oxide - Metal+composite
ceramic post - Metal+glass ionomer
 Types of Post Retained Crown
Passive posts
(2) Performed posts
(prefabricated posts)
Examples
(b) Fiber posts
• Carbon fibre posts (carbon
fibres embedded in a polymer
resin, usually epoxy resin)

.
 Fiber post
• silica-fibre or quartz-fibre post.

• Similar modulus of elasticity to dentine

• Biocompatiple
• Monoblock
• Aesthetic
 According to method of
construction

Ready made Custom made

Ready made
 Preparation of the Post Canal
Space
• Involves the following steps

1. Removal of the root filling material

2. Preparation of the post space
3. Preparation of remaining coronal tooth
structure
Custom made
 Preparation of the Post Canal
Space
• Involves the following
steps
2. Preparation of the post
space
Custom posts
• Usually used with post
space that is not
circular or extremely
tapered.
 Preparation of the Post Canal
Space
• Involves the following
steps
2. Preparation of the post
space
Custom posts
• Minimum shaping is
required.
 Preparation of the Post Canal
Space
• Involves the following steps
2. Preparation of the post space
Custom posts
• Could be fabricated from
• Direct Patterns
• Indirect patterns
 Direct

Autopolymrizing
Resin
 Preparation of the Post Canal
Space
• Involves the following
steps
2. Preparation of the post
space
Custom posts
• Direct Patterns
• Lubricate the canal with
vasline and insert the resin
frequently removing the
pattern until completely
set & build up the core
with the same material.
 indirect

Impression
 Preparation of the Post Canal
Space
• Involves the following
steps
2. Preparation of the post
space
Custom posts
• Indirect Patterns
• Cut a piece of
orthodontic wire to form
a J shape.
 Preparation of the Post Canal
Space
• Involves the following steps
2. Preparation of the post space
Custom posts
• Indirect Patterns
• Seat the wire into full depth
 Preparation of the Post Canal
Space
• Involves the following steps
2. Preparation of the post space
Custom posts
• Indirect Patterns
• Add additional material with impression syringe
 Preparation of the Post Canal
Space
• Involves the following steps
2. Preparation of the post space
Custom posts
• Indirect Patterns
• Add impresion to the stock
tray
• Wait till impresion sets and
remove the tray
• The post is further processed
in the lab .
2022-10-31 107
 Summary

• the most critical aspect when dealing with a

nonvital tooth is “tissue preservation.

• providing adequate ferrule

• amount of remaining sound tooth structure
should be considered key in assessing
restorability.
• Teeth with RCT and no crowns have a six fold
risk of failure

• Molars require cuspal protection

Restoration of endodontically treated teeth