Post and Core

Dr. Saritha L.M.

CONTENTS
Introduction History Key words and definitions Post Core Ferrule Pins Pretreatment e a!uation Endodontic consideration Restorative evaluation Periodontal considerations Esthetic evaluation Prosthodontic evaluation Consideration in restorin" endodontica!!y treated teeth 1. Effects of endodontic treatment a. The role of moisture loss on the nature of dentin b. Alterations of strength due to architectural changes in the morphology of the teeth. c. Concepts of biomechanical behavior of tooth structure under stress. d. Nature of dentin toughness in pulpless teeth. e. Changes in the nature of the collagen alignment in pulpless teeth. . Anatomic and biologic considerations a. The amount of remaining tooth structure b. The anatomic position of the tooth. c. The functional load on the tooth. d. The esthetic re!uirements for the tooth.

 #estoration desi"n and se!ection 1. Provide a good coronal seal . Protect" conserve remaining tooth structure #. $atisfy functional and esthetic considerations Criteria that determine !on" term $ro"nosis in restoration of endodontica!!y treated teeth Timin" of tooth restoration Indications Anterior Posterior Contraindications Post% dowe! %efinition &deal re!uirements of post and core C!assification of $ost core. &actors affectin" retention of $ost systems 1. Post length . Post diameter #. Post design '. (uting agents ). (uting methods *. Canal shape +. (ocation in the arch ,. -enting .. $urface roughness #etention triad Post length Post style (uting agent

 #esistance triad Cro/n bevel -ertical remaining tooth structure Antirotation &actors affectin" se!ection of $ost and core systems Ty$es of $osts Custom made post and core Prefabricated Custom made $ost and core &ndications Contraindications Advantages %isadvantages Prefa'ricated $ost &ndications Contraindications Advantages %isadvantages C!inica! $rocedures for $ost and core systems Post space preparation Removal of gutta percha Chemical removal 0echanical removal Thermal removal Cast $ost core fa'rication techni(ue 1 %irect techni!ue 1 &ndirect techni!ue 1 Fabrication of multiple posts and cores using a thermoplastic material and indirect techni!ue 1 $plit cast techni!ue

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 Prefa'ricate dowe!s and cores Prefabricated precision plastic do/el Prefabricated metal do/el core Prefabricated do/el" composite resin core Threaded do/el Core #e(uirements Materia!s used) Cast gold Amalgam Composite resin 2lass ionomer R02&C *!ternati e $refa'ricated $ost and core systems uti!i+in" materia! a ai!a'!e Pro isiona! restorations for endodontica!!y treated teeth Functions Esthetic role Protects the tooth from further damage Prevents migration of ad3acent contacting teeth Provides occlusal function %ifferent provision restorative materials Polycarbonate Cro/n Clear Plastic $hell Cementation 4inc phosphate cement Polycarbo5ylate cement 2lass ionomer cement Resin modified glass ionomer cement Resin cement

 Stress ana!ysis methods used for $ost and core Photoelastic stress analysis Finite element stress analysis Post remo a! 0asserann techni!ue The (ittle giant post puller 6anematsu do/el removing plier $.$ 7hite post e5tractor Post puller 2onon post removing system $aca Pino post e5tractor 8ltrsonics #ecent ad ances &uture trends Conc!usion ,i'!io"ra$hy

INT#OD-CTION
9Teeth and artificial dentures: fastened /ith posts and gold /ire: hold setter than all others. They sometimes last fifteen to t/enty years and even more /ithout displacement . . .; Piree Fauchard < 1+'+. Endodontic treatment saves the tooth from e5traction but only ade!uate restoration /ill reinstate it as a long1term functioning member of the mouth. The restoration of a tooth by root canal treatment is of limited value unless the cro/n of tooth is satisfactorily restored. The manner in /hich a root canal filled tooth is restored is therefore considerable importance. The restoration of endodontically treated tooth is complicated by the fact that much or all of the coronal tooth structure /hich normally /ould be used in the retention of the restoration has been destroyed by caries: previous restorations: trauma: and the endodontic access preparation itself. The endodontically treated tooth is a uni!ue subset of teeth re!uiring restoration because of several factors such as dehydrated dentin: decreased: decreased structural integrity and impaired neurosensory feed bac= mechanism /hen compared to a vital tooth. >o/ever: the treatment goal must be based upon a multitude of factors specific for each patient: so that the strategic architectural aspects that have"greatest impact on the ultimate strength of the pulpless tooth can be restored"reinforced. $olution to this problem has challenged the inventiveness and ingenuity of dentists for centuries. The endodontically treated tooth must be fortified in such a /ay that it /ill /ithstand both vertical and lateral forces and not be sub3ected to fracture. Amalgam as routinely used to restore a tooth is not considered the best choice: since the cusps are left unprotected and are sub3ected to vertical fracture. The use of a cro/n over an endodontically treated tooth: by itself is not recommended. Further reduction of already undermined /alls may render the treated tooth sub3ect to hori?ontal fracture at or near the gingival line. An inlay: in so far as it too is an intracoronal restoration: leads to same /ea=ness as the amalgam. This leaves the consideration an onlay: /hich covers the cusps

and protects against vertical fracture. $till the potential for hori?ontal fracture remains: since the pulp chamber is usually undermined. For these reasons vertical support must be added to all of the restorations mentioned so that they may be strong enough to protect the treated tooth from hori?ontal fracture. Reinforce the treated tooth and protect against vertical fracture: some type of stabili?ation is re!uired that /ill fasten the restoration to the remaining tooth structure. This is accomplished by using a post @also referred to a do/elA: preferably /ith a core or coping and a cro/n or onlay as superstructure to give coronal1radicular stabili?ation. A post and core is a restoration consisting of a post that fills a prepared root canal and a core inserted into the pulp chamber that establishes the proper coronal tooth preparation. The post and core is made /ith a rigid material /hich: /hen cemented into the root canal and pulp chamber provides a solid foundation restoration that is /ell retained in the tooth. $o the primary function of a post is to aid in retaining a core to restore lost tooth structure for retention of a restoration and not to provide strength or resistance to fracture.

HISTO#.
Restoration of endodontically treated tooth by a post to retain a cro/n dates bac= more than )B years. 1728 Pierre Fauchard described the use of 9TENCN$; /hich /ere metal posts scre/ed into the roots of teeth to retain the prosthesis 1745 Claude Mouton published his design of a gold cro/n /ith a gold post that /as to be inserted into the root. 1830-1870 Wood replaced metal as the material of choice for posts. 1839 Harris in proposed that gold and platinum /ere superior to brass: silver and copper /hich tended to corrode. 1849- To e! proposed the principles of post dimension. 1849 "r#F#H#Clar$ < developed 9spring loaded do/el; a retentive device consisting of a metal tube in the canal D a split metal do/el /hich /as inserted into it. &t /as designed to allo/ for the easy drainage of suppuration from /ithin the canal or apical areas. %#&# 'lac$ developed porcelain fused to metal cro/n held in by a scre/ inserted into a canal filled /ith gold foil. 1871 Harrie! introduced /ooden posts. >o/ever: they s/elled D caused roots fracture. (Pi)ot cro*n+ < a /ooden post fitted to an artificial cro/n and to root canal 1884 ,o-an cro*n 1888 .ich ond cro*n (ater 1.th century: single piece post cro/n. 1930 cu!to ca!t /o!t / core replaced the one piece post cro/ns or Richmond cro/n. 19001! Pre2a3ricated /o!t < core systems introduced 19901! 45hillin3ur- 19976 < /idely used prefabricated post < core systems. 1990 "uret et al described a non metallic material for the fabrication of posts based on carbon fibres reinforcement principle.

Key words and definitions

Post or dowe!) The do/el is a post or other relatively rigid: restorative material placed in the root of the non1vital teeth. The foremost purpose of the do/el is to provide retention for the core and coronal restoration. Core) &s defined as properly shaped and /all restored substructure /hich replaces missing coronal structure and retain the final restoration. &erru!e) &s %efined as a #*BB metal collar of the cro/n: surrounding the parallel /alls of the dentin e5tending coronal to the shoulder of the preparation /hich resists stress e5erted during post insertion. PinsE 8sed alone or in combination /ith posts to provide retention for core material. &ina! restorationE The form of cro/n given after post " core.

2utta percha

Post

Core

Final restoration

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P#ET#E*TMENT E0*L-*TION
Fefore initiation of restorative therapy the tooth must be thoroughly evaluated to ensure success of all ultimate treatment goals. The tooth should be e5amined individually and in the conte5t of its contribution to the overall treatment plan1 . 1. Endodontic consideration . Restorative evaluation #. Periodontal considerations '. Esthetic evaluation ). Prosthodontic evaluation Endodontic consideration) Guality of endodontic treatment is of immense importance prior to restorative procedure: it is essential that endodontic treatment be successful. %ense: uniform: three dimensional obturation @fluid impervious sealA of the root canal system: B.) to 1 mm from the radiographic ape5 of the root"roots is necessary. Previous endodontic treatment re!uires evaluation. $hould the tooth e5hibit signs or symptoms indicating failure: re1treatment procedures should be accomplished prior to restoring the tooth. &f incomplete root canal fillings: poorly instrumented or condensed canals: poorly adapted fillings @voidsA and untreated canals are evident in the absence of clinical signs and symptoms indicative of failure: they also should be corrected prior to the restorative procedures1 . #estorati e e a!uation &t is essential to determine if the tooth is restorable before endodontic treatment is performed. Restorative evaluation is mandatory before any definitive therapy. $uccessful endodontic treatment is of no value if a tooth is too e5tensively damaged from caries: fracture: previous restorations: or periodontal disease to be reliably restored. $trategic importance of a tooth should be determined before a final plan is formulated. The reliability and prognosis of a tooth should be considered before the final treatment plan. The tooth to be retained must be able to /ithstand the functional forces placed

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upon it after reconstruction. 0issing tooth structure can be replaced /ith a cast restoration: a core and a do/el. A critical amount of solid coronal dentin is re!uired: /hich must encase a coronal restoration for structural integrity of the restored tooth. The ferrule @i.e. a band of metal that encircles the e5ternal dimension of the residual toothA has been sho/n to significantly reduce the fracture in the endodontically treated teeth. &f insufficient solid tooth structure to accommodate a restoration /ith ferrule is not available: the tooth should first be treated periodontally or orthodontically and then restored. Ferrule effect using a contra bevel in preparation of do/el core acts as an antirotational device and as positive occlusal seat for the post system1 . Periodonta! Considerations A very important consideration /hen restoring an endodontically treated tooth is the periodontium because the ultimate prognosis for a given tooth is dependant on its periodontal status Periodontal disease should be treated prior to placement of definitive restorations. 1. A healthy periodontium provides the best prognosis for the tooth and /ill ma=e the procedures such as placement of margins and ma=ing of an impression easier and more accurate. . 7henever there is a substantial loss of tooth structure: cro/n lengthening /ill be re!uired toE a. Provide ade!uate isolation for endodontic therapy b. Re1establish the biologic /idth and c. Provide coronal tooth structure to incorporate a ferrule into the cast restoration. . %imensions of the attachment apparatus range from 1.++ mm to .'# mm. This means that there should be an absolute minimum of .) mm distance bet/een the restoration margin and the crest of bone.

#. Fiologic /idth relates the amount of tooth structure coronal to the osseous crest to the gingival attachment apparatus. '. As a general rule: a minimum of # mm of sound tooth structure coronal to the osseous crest /ill be necessary to accommodate the connective tissue attachment: the 3unctional epithelium: and the margin of the cro/n. Esthetic e a!uation12) Potential esthetic complications should be investigated before initiation of endodontic therapy. 1. Thin gingiva may transmit a shado/ of dar= root colour through the tissue. . 0etal or dar=: carbon fibre do/els or amalgam placed in the canal can result in unacceptable gingival discolouration from the underlying spot. #. The translucency of all ceramic cro/ns must be considered in the selection of do/el and build up materials. '. Tooth coloured carbon cores: fibreglass reinforced composite resins: or ?irconia do/els can be used in esthetic areas. ). $imilarly tooth coloured: rather than opa!ue: composite resins should be selected for the esthetic cases. *. The colour and translucency of most uncro/ned teeth /ill be adversely affected by opa!ue substances. +. %iscolouration from gutta1percha can be visible in the coronal aspect of an endodontically treated tooth and thus should be limited to an apical level in the root. ,. Endodontic and restorative materials in these esthetically critical cases must be selected to provide the best health service /ith the minimum of esthetic compromise. Accurate assimilation of endodontic: periodontal: restorative: and esthetic variables /ill contribute to a rational successful treatment outcome.

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Prosthodontic e a!uation12 1. Additional factors affecting prognosis are tooth type: morphology: arch position: the occlusal and prosthetic forces applied to the tooth and the periodontal support of the tooth. . Tooth structure may be lost due to a variety of reasonsE caries: previous restorative treatment: traumatic in3ury: attrition: erosion: abrasion: and resorption. #. E5tent of tooth destruction is very important in deciding the restorative techni!ue. '. Contrary to the popular belief: posts do not strengthen the tooth. Primary function of the post is to provide retention for the core.

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CONSIDE#*TIONS IN #ESTO#IN3 ENDODONTIC*LL. T#E*TED TOOTH

The restoration of endodontically treated teeth has been the focus of considerable controversy and empiricism. Time1 tested methods have been highly successful in some respects: but failure is still apparent. Regardless of the system there should be a through understanding of the anatomy: and biology of dentin and root supporting the restoration on the part of the practitioner to support the contention that endodontically treated teeth have special needs that e5ceed the re!uirements of teeth /ith vital pulp. These uni!ue aspects include: AA Effect of endodontic treatment on teeth FA Anatomic and biologic considerations.

E&&ECT O& ENDODONTIC T#E*TMENT ON TEETH 42 aA bA the teeth. cA dA eA Concepts of biomechanical behavior of tooth structure under stress. Nature of dentin toughness in pulpless teeth. Changes in the nature of the collagen alignment in pulpless teeth. The role of moisture loss on the nature of dentin Alterations of strength due to architectural changes in the morphology of

#o!e of moisture !oss) The moisture content of the coronal dentin is appro5imately 1#. H. As the age increases the moisture content decreases due to increased deposition of peritubular dentin /hich contains more organic content and /ater. T/o ma3or components of /ater content in any calcified tissues are: 1A Cutside the calcified matri5: 1)

A 7ithin the calcified matri5.

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7ater /ithin the calcified matri5 is divided in to: iA iiA Free /ater to hydrate inorganic ions thus being involved in their movement < Fut this /ater can be removed at bet/een 1BBBC and 11BBC. Firmly bound /ater: this doesnIt participate in the movement of ions. This firmly bound /ater is called the 9/ater of hydro5yapatite crystal; and is not substantially reduced until temperature of *BBBC is reached. &t is demonstrated that the pulpless tooth contains .H less moisture than the vital tooth and this /ater loss is a irreversible damage and can not be recoverable even in saturated atmosphere and at body temperature.

*rchitectura! chan"es) The decreased strength seen in endodontically treated teeth is primarily because of the loss of coronal tooth structure. Endodontic procedures reduced tooth stiffness by a mere )H attributed primarily by access opening. 7hile a 0C% cavity preparation reduces tooth stiffness by more than *BH /ith loss of marginal ridge contributing the greatest loss of tooth strength. 7ith the reduction of the inner cuspal slopes that unite and support: or e5posure of acute cuspal angles a greater chance of fracture e5ists. Conversely the e5cessive removal of radicular dentin during cleaning and shaping or post space preparation compromises root strength.

Photoelastic models sho/ing concentration of stress increases at the base of the cusps /hen the roof of the pulp chamber is removed

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,iomechanica! 'eha ior) The behavior of teeth under load has been investigated and has provided information into the changes occurring in the pulpless tooth. Tidmarsh described an intact tooth as a hollo/ laminated structure that deforms under load. This laminated structure may shorten: its sides may bulge: and its cusps may be /edged apart by opposing cusps. Although under physiological loads: complete elastic recovery ta=es place: permanent deformation may follo/ very high " e5cessive on sustained loads. Therefore the tooth appears to respond li=e a prestressed laminate. &t is characteristic of such a structure that it can /ithstand greater loads in the prestressed rather than in the unstressed state because in the prestressed state it can fle5 /ith the varying degree and angle of load. >o/ does this prestressed state come about in the toothJ Cne hypothesis suggests that as the cro/n develops: the out/ard movement of the ameloblasts and the in/ard movement of the odontoblasts set up the stressed condition: /hich is then fro?en or stabili?ed by minerali?ation of the matri5. The significance of this phenomenon is that any cavity preparation: ho/ever small: destroys the prestressed state and releases the stresses. This phenomenon is crucial if the cuspal inner slopes are removed during endodontic access preparation or cavity preparation thus destroying the prestressed state. $ubse!uently: stress is released: accompanied by a slight shift in cuspal structure. >o/ever: the tooth can deform to a greater e5tent under applied loads and thus be more susceptible to fracture. This concept /ould apply to teeth /ith endodontic cavity preparation and /ould be integrated in the nature of cuspal anatomy: its bucco1lingual /idth: and the angle of inclination.

Dentina! tou"hness) The toughness is measured by the total energy re!uired to fracture a material. Another techni!ue to determine the toughness of a material in micro indentation imprints made in a material /ith specific loads and the depth of indentation indicates a measure of hardness of material. 1,

%entin e5hibits considerable plastic deformation beyond the yield point: it is a /ea= biologic ductile material in /hich strength and toughness may vary. The shear strengths and toughness values of dentin from endodontically treated teeth is lo/er and significantly different from the values for dentin of vital teeth. &t is demonstrated that 1'H reduction in the strength and toughness is seen in endodontically treated teeth. Co!!a"en a!teration) %entinal collagen consists of large fibrils characteristic of type & collagen. The intermolecular cross lin=ing of collagen fibers achieve their characteristic physical properties of rigidity: resistance of strength and remar=ably high tensile strength. &t Accounting for decrease in tensile strength and brittleness of pulpless teeth. 7hen all above five aspects of dentinal changes are integrated a reasonable e5planation for the changes in the strength of the tooth structure are pulpless teeth can be formulated. These are fundamental: irreversible changes in the anatomy: biochemistry and biomechanical properties of dentin /hich ma=es up the bul= of remaining tooth structure after pulpal loss and endodontic treatment. %entin of pulpless teeth undergoes alteration in its inherent structure: reducing is tensile strength and fle5ibility. Fecause of the moisture loss and architectural changes of tooth structure < root filled teeth re!uire uni!ue restorative procedures related to their radicular anatomy and supporting bone. is verified that there are more immature and fe/er mature cross lin=s in root filled teeth <

*N*TOMIC *ND ,IOLO3IC CONSIDE#*TIONS Cther than the alterations made by endodontic therapy some other important considerations during post endodontic restorations they are: aA The amount of remaining tooth structure bA The anatomic position of the tooth. cA The functional load on the tooth. dA The esthetic re!uirements for the tooth.

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The various combinations of these factors /ill determine the selection of posts: cores: cro/ns and the techni!ue of the treatment procedure. a5 The amount of remainin" tooth structure) The amount of tooth structure damage is one of the most important aspects in restoration of endodontically treated tooth. The amount of remaining dentin is far more significant to the long term prognosis of the restored tooth than in the selection of artificial post: core or cro/n materials. Teeth /ith minimal remaining tooth structure present several clinical problems: these include. iA iiA iiiA ivA An increased root fracture ris=. A greater potential for recurrent caries. 2reater chance of restoration dislodgement or loss. An increased incidence of biologic /idth invasion during preparation.

'5 The anatomic $osition of the tooth) *nterior teeth) A nonvital anterior tooth that has lost significant tooth structure re!uires a cro/n. The cro/n is supported by and retained by the post and core. %esired physical properties of Posts /ill determine the selection of materials for the cro/n: core: post: esthetic post and core materials are preferred here. Posterior teeth) Posterior teeth carry greater occlusal loads than anterior teeth: and restorations must be planned to protect posterior teeth against fracture. The functional forces against molars re!uired cro/n or onlay protection. c5 &unctiona! !oad of the tooth and $rosthetic needs) The hori?ontal and tor!uing forces endured by abutments for fi5ed or removable partial dentures dictate more e5tensive protective and retentive features in the restoration. Abutment teeth for long span fi5ed bridges and distal e5tension: removable partial denture absorb greater transverse load and re!uire more protection than do abutments of

smaller bridges or tooth supported removable: partial dentures. $imilarly teeth that e5hibit e5tensive /ear from bru5ism: heavy occlusion or heavy lateral function re!uire the full complement of post: core and cro/n. d5 Esthetic re(uirements of the tooth) Esthetic changes occur in endodontically treated teeth. Fiomechanically altered dentin modifies light refraction through the tooth and modifies its appearance. &nade!uate endodontic cleaning and shaping of coronal area also contribute to this discoloration. Anterior teeth: premolars and often the ma5illary first molar inhabit the esthetic ?one of the mouth. These teeth are framed by the gingiva and lips to create an esthetically pleasing smile. Teeth in the esthetic ?one re!uire careful selection of restorative materials and careful handling of tissues.

*N*TOMIC CONSIDE#*TIONS
#adicu!ar considerations) There remains a tremendous dependency on the radiograph as the essential diagnostic aid for determining the anatomy of the root to be restored. 7hile routine periradicular radiographs provide only t/o1dimensional cross1sectional anatomy of the radicular tissues from mesial to distal: supplemental: vie/s from pro5imal or occlusal angulation /ill supply additional information regarding the curvature or e5tra roots. >o/ever: since the e5act facio1lingual dimensions or the mesiodistal shape including the presence of invaginations or laminations of the roots bet/een the facio1 lingual dimensions of the root cannot be accurately ascertained: it is imperative to have a thorough =no/ledge of the root anatomy before reconstructing the tooth. &n teeth that need a post to retain a core build up careful attention must be directed to the root anatomy for selecting the appropriate post design: including shape: length: and method of placement. 1 0a5illary central and lateral incisors < have sufficient bul= of root to accommodate most post systems.

Care must be e5ercised in using posts /ith e5cessive length if the root tapers rapidly to the ape5 < because the thinner the root /alls at the depth of the post placement: the greater the chance for root fracture.

0a5illary canines < have /ide faciolingual roots D root canal spaces that commonly necessitate a custom cast post for desired adaptation to the root /alls and there is a possibility of pro5imal root invaginations.

Restoration of ma5illary premolars < presents a variety of problems /hen one anticipates a post1retained core. Root /alls are commonly thin: and root tapers rapidly to the ape5: especially /hen t/o distinct roots are present.

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Pro5imal invaginations and canal splitting are common during preparation of the canal from the coronal to apical root structure. Root curvatures to the distal are common1preclude using long posts. The curvatures of the palatal root can be facial: results in root perforation during post space preparation or cementation. Thinness of these roots < removal of dentin for the placement of a post results in a /ea=ened root /all /hich in turn leads to fracture either cementation or during function.

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$ame observations are true for the second premolars: but these teeth generally have greater bul= of tooth structure. 0a5illary molarE $uitable root K Palatal root. Even this root presents restorative problems. ,)H of the palatal roots curve

facially and /hen invaginations are present they are located on the palatal and facial surfaces. This combination of root curvature and radicular invaginations predisposes the root /alls to /ea=ening or perforation during placement of long or thic= posts. As a result palatal roots can be fractured: re!uiring root resection: tooth e5traction or surgical endodontics to repair the perforation. Placement of posts in the 0F and %F roots is contraindicated. Mandi'u!ar incisors) %ifficult teeth to restore /ith a post and core < and success rates have been higher /ithout a post root /alls are thin and pro5imal invaginations are common.

Placement of a post is commonly compromised by multiple canals /ith significant bone loss: precluding the placement of a post in an unsupported root. This problem /as identified by Reinhardt et al < in teeth restored /ith a post and core having diminished bone support of '1*mm: stress concentration occurs both at the post ape5 and on the ad3acent root periphery in a relatively narro/ band of remaining dentin1potential for fracture in greater. Mandi'u!ar canines) similar as ma5illary canines.

Mandibular premolars: >ave sufficient bul= of root structure. Care must be e5ercised to ensure that the entire root canal has been managed become there is a proclivity for multiple canals. Cne area of concernE /ith first premolar is the angle of the cro/n to the root. Cften the root /ill be lingual inclined and active drilling of a post space perpendicular to the occlusal surfaces /ill result in a perforation along the facial /all of the root. Mandi'u!ar mo!ars) 0a3or problem due to mesiodistal thinness of the mesial and distal roots. Along the root curvatures: there are commonly invaginations and perforations that are invisible radiographically. The roots may be substantially /ea=ened if they are prepared for prefabricated circular posts < because the roots are e5ternally /ide facio1lingually and narro/ mesiodistally. &n these cases: fracture may occur during post cementation or patient function. These types of fractures have been termed 9C%CNT(ATRC2EN&C; in origin and should be recogni?ed by the dentist.

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#ESTO#*TI0E DESI3N *ND SELECTION Factors to be considered in design and selection 1. provide a good coronal seal . protect" conserve remaining tooth structure #. satisfy functional and esthetic considerations Corona! Sea! &ngress if oral fluids and bacteria leads eventually to sealer dissolution: /hich reestablishes a path/ay of communication bet/een oral environment and the periapical tissues. Coronal lea=age of bacteria from saliva into root canal fillings material is a potential cause of failure. This problem may be more pronounced /hen only a small volume of obturating materials remain in the canal: such as after post preparation. >ence: it is necessary that the post endodontic restoration must provide a good coronal seal. Conser ation of tooth structures A more conservative tooth preparation minimi?es the ris= of cro/n an root fracture. 7ith narro/ single rooted teeth such as mandibular incisors preservation of tooth structure is especially important: and custom cast post: have been reported to offer better retention and resistance to fracture compared /ith parallel sided serrated posts. $trict adherence to the guideline of parallelism of the post space may result in over preparation of the apical termination of the post preparation that can also concentrate stresses /here the radicular dentin is thinned and /ea=ened. $lightly tapered posts are easier to prepare and more conservative: because most roots are tapered. The gutta percha filling is removed to the desired depth and residual endodontic sealer or undercut are eliminated. The resultant slightly tapered post is designed to fit the available space. #einforcement and retention Pulpless teeth fre!uently remain relatively intact after endodontic treatment /ith conservative access. Although: it has never been ade!uately demonstrated that an endodontically treated tooth is more brittle than a vital tooth: fracture s of pulpless teeth

during mastication have occurred. Restoration and reinforcement ofpupless teeth is an important preventive measure in endodontic treatment since: failure to do so may invite future problems or embarrassing mishaps.

C#ITE#I* TH*T DETE#MINE LON36TE#M P#O3NOSIS IN #ESTO#*TION O& ENDODONTIC*LL. T#E*TED TEETH) 7ourna! of Esthetic Dentistry 1889: 1;<25) +)1,# C#ITE#I* &orce P*#*METE# &ntensity 0*#I*,LE Area of mouth: La/ angle: 0uscle strength: Parafunctional habits: Type of contact"food: Fre!uency %uration: %irection @lateral"rotational" compressive" #estoration Com$onent retentive A Cperative Restoration Tooth Material strength: Compression: cro/n to root ratio: periodontal support tooth mobility. Che/ing: Clenching: 2rinding Parafunctional Tooth: cusp: Ccclusal table: inclination: position: $i?e

shear"tensile: elasticity modulus: modulus effects: thermal coefficient of e5pansion: internal stress: stability and fatigue. Surface area: Cverall height: /idth: length: cross sectional shape: bo5 formation: pins. Mechanical contactE si?e of contact: position and type @flat: point: /edgeA. Interaction of material: 7etability: chemical interaction: thermal micro"macro mechanical

Core: Post: Cement: of deformation: yield strength: pre1stress

contact: chamber shape: bo5 formation:

Interface

Restoration to core: to o5idation: electrolysis: mechanical /ear: post: to cement: to stress: tooth mechanical /edging: coefficient of e5pansion

Timin" of tooth restoration) 1. 8ntil an endodontically treated tooth is restored to full function: treatment is incomplete. . Coronal lea=age is a significant etiology in endodontic failure. #. &f obturated canal is e5posed to saliva: lea=age /ill occur and compromise the gutta1percha seal: and the tooth may re!uire re1treatment. '. 8nrestored endodontically treated tooth is more susceptible to fracture. ). 0odern endodontic therapy achieves a predictably high success rateM postponing restoration for e5tended periods of time to be certain of endodontic success is unnecessary and could place the tooth at ris=.

INDIC*TIONS
*nterior 1. 7here the natural cro/n of root1filled teeth either has been lost " e5tensively damaged. . &f complete coverage restoration is indicated for endodontically treated teeth for esthetics or functions. #. Functional re!uirements1 if there is a doubt regarding the ade!uacy of the resistance form of the coronal portion of the tooth to support the cro/n '. 0alaligned teeth ). (oss of t/o pro5imal surfaces /ith a lingual endodontic access opening /hich /ea=ens the tooth. *. 7here the root1filled tooth is to be used as bridge abutment. +. 7here a change in a5ial position greater than 1mm is re!uired. Posterior 1. 7hen other more conservative retention and resistance features cannot be used for core li=e chamber retention: amalgam pins etc . 7hen a tooth is to serve as an abutment for a removable partial denture #. &n premolars if the remaining coronal tooth structure is inade!uate: the clinical cro/n is tall in relation to its diameter at the point /here it enters the alveolar bone: or if the tooth receives significant lateral stresses '. &n case of malposed teeth: /hen preparation of tooth /ould cause e5posure of the pulp1 of choice for aligning coronal portion of the tooth.

CONT#*INDIC*TIONS 1. $evere curvature of the root1egE %ilacerations of the root. . Persistent periapical lesion #. Poor periodontal health '. Poor cro/n to root ratio ). 7ea= " fragile roots *. Teeth /ith heavy occlusal contacts +. Patients /ith unusual occupational habits ,. Economic factor D inade!uate s=ill

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POST
Dowe!%Post) The do/el is a post or other relatively rigid: restorative material placed in the root of the non1vital teeth. The foremost purpose of the do/el is to provide retention for the core and coronal restoration. The do/el is especially important in restoration of non1vital teeth that have suffered significant damage and have insufficient sound tooth structure remaining above the periodontal attachment to secure a coronal restoration. The do/el itself does not strength a tooth: on the contrary: the tooth is /ea=ened if dentin is sacrificed to place a large diameter do/el. Idea! $ro$erties of the dowe!) 1. 0a5imum protection of the root. . Ade!uate retention /ithin the root. #. 0a5imum retention of the core and cro/n. '. 0a5imum protection of the cro/n1margin1 cement seal ). Pleasing esthetics: /hen indicated. *. >igh radiographic visibility. +. Retrievability. ,. Fiocompatibility. .. 0aterial compatibility /ith core. 1B. 0inimum stress during placement and cementation tissue. 11. Ease of use: safety: reliability 1 . %istribution of functional stresses evenly along the root surfaces. 1#. Physical properties similar to dentin 1'. Reasonable cost.

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CL*SSI&IC*TION O& POSTS I. 7# Cu!to 1. . #. '# 1. . #. '. ). ca!t Po!t!8

Endopost Endo/el Parapost Pre2a3ricated /o!t!8 Parallel sided < serrated and vented. Eg. Para post. Tapered self threading systems. Eg. %entatus. Tapered smooth sided systems. Eg. 6err: Ash. Parallel sided threaded post systems.Eg.Radi5 Anchor: 6urer Anchor post system. Parallel sided: threaded: split shan= systems. Eg. Fle5i post.

II. 7# Pa!!i)e retention /o!t!8 1. . #. '# 1. . Cast posts $mooth tapered posts $errated parallel posts 7cti)e retention /o!t!8 Fle5i posts 6urer Anchor posts

III. Ty$es of non6meta! $osts) 7# 'a!ed on co /o!ite aterial!8 1. Car'on &i're $osts) a. Composipost b. Carbonite c. Endopost d. 0irafit carbon 2. Si!ica &i're $osts) a. Aesthetipost b. Aesthetiplus c. (ight post d. $no/ post e. Parapost fibre /hite f. Fibre1=or 4. Li"ht transmittin" $osts) a. (ight post b. (uscent anchor post =. #i''on fi're $osts '# 'a!ed on cera ic!8 1. Cosmopost

>ed"e or conica!!y sha$ed $osts) A. Threaded and tapered F. $mooth conical /ith grooves C. $errated and conical Para!!e! sided $osts) A. Threaded and parallel F. Parallel and self threading C. Parallel and serrated

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NE> #ESTO#*TI0E CL*SSI&IC*TION O& ENDODONTIC*LL. T#E*TED TEETH ) ,y Pau! #. Cha!ifou? The classification is based on the number of canals: amount of coronal tooth structure: chamber space: canal !uality: and orientation. Classes 1: D# refer to teeth /ith one: t/o or three canals. Each of these classifications is further subdivided into complete @cA: partial @pA D no @nA coronal tooth structure. Complete coronal tooth structure comprises a range of **11BBH: partial: ## to *)H and no.B to # H. The percentage of remaining coronal tooth structure: after root canal and restoration preparation is defined as the least of the t/o percentagesE C!ass 1 @one canalA @t/o canalsA # @three canalsA Tooth structure Complete @CA: partial @PA: No @NA Complete @CA: partial @PA: No @NA Complete @CA: partial @PA: No @NA C K **11BBH: P K ##1*)H: N K B1# H

Su' c!assification ) Chamber space Present Absent Canal !uality $hape $egmentedE straight: curve 8niformE straight: curved %iameterE uniform: segmented (engthE straight: normal: long 8niformE parallel: tapered $egmentedE parallel: tapered Canal1canal: canal1component &nterloc=ing: limited interloc=ing: non1 interloc=ing

$i?e Taper Canal orientation Parallel interloc= ing

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&*CTO#S *&&ECTIN3 #ETENTION O& POST S.STEMS (Journal of prosthetic dentistry 1999, 81(4): 8!" 8# 1# Po!t len-th8 a. $hould be longer than cro/n. b. d. At least 1"#rd the length of cro/n. End half/ay bet/een the crestal bone and root ape5. c. $hould be a certain fraction of the root lengthE such as 1" : "#. e. As long as possible /ithout disturbing apical seal. 2# Po!t dia eter8 a. &ncreasing diameter does not provide significant retention. b. &ncreases stiffness of the post at the e5pense of the remaining dentin and the fracture resistance of the root decreases. c. %oodacre1post diameters should not e5ceed 1"#rd of the root diameter at any location. d. Post diameter must be controlled to preserve radicular dentin: reduce the potential for perforation and permit the tooth to resist fracture.

Three different philosophies regarding post diameterE 1. Conservative approachE Advocated by 0attison < to restrict the diameter of the post to conserve the remaining tooth structure. &ncrease in post diameter1elevates stress in the radicular surface. . Proportionist approachE Advocated by $tern and >irschfeld < optimal diameter one1third the diameter of the root. &t preserves sufficient tooth structure. #. Preservationist approachE advocated by >alle et al < proposed the preservation of at least 1.+) mm of sound dentin around the entire circumference of the post1 sufficient to resist fracture of the tooth.

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For selecting the post diameter < suggested that the proportionist and preservationist approach be applied.

3# Po!t de!i-n8 Tapered posts produced the greatest stress at the coronal shoulder: D parallel posts generated greatest stress at the ape5 of the canal preparation. Cf the threaded designs: the tapered scre/ produced the greatest /edging effect D highest stress levels. The parallel sided: serrated: vented post produced stresses that /ere distributed most uniformly along its length and appeared best able to protect the dentin. Parallel sided threaded posts that are tapered may be considered /hen additional retention is needed. 4# ,utin- 7-ent!8 a.(uting agents: including ?inc phosphate: polycarbo5ylate: glass ionomer D filled and unfilled resin cements have been investigated e5tensively. b. Foth ?inc phosphate and glass ionomer cements are fre!uently used because of their ease of manipulation along /ith their history of success in luting procedures 5# ,utinethod!8 b.Paper point: d.Needle tube

0ethods of applying luting agent into the canal space a. (entulospiral: c.Endodontic e5plorer.

After luting agent is placed in the canal: post is coated /ith the luting agent D inserted. 0# Canal !ha/e8 Predominant canal shape is ovoid and the /alls of prefabricated posts are parallel. Pre/aration o2 the canal !/ace and tooth a.0ethods used areE rotary instruments: heated instruments and solvents. b. 0inimum of # to ) mm of gutta1percha must remain to preserve apical seal.

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c.For each prefabricated system: the accompanying t/ist drill is then used to shape the canal follo/ing the direction and depth created by the hand instruments. d. $tops should be placed on engine driven drills at the desired depth as an added precaution. 7# ,ocation in the dental arch8 The location of the tooth in the dental arch necessitates different restorative re!uirements to ensure the longevity of endodontically treated teeth.

9. &entinFecause of intraradicular hydrostatic pressure created during cementation of the post: a means for cement to escape must be provided. A vent may be incorporated in the pattern before casting or cut into the post /ith a bur prior to cementation.

9# 5ur2ace rou-hne!! $urface roughening: such as air abrading or notching: of the post increases post retention

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#etention Triad@9
Retention is defined as the force that resists a tensile or pulling force. Retention can be gained in three /ays 1. Ade!uate $ost !en"th in the canal . $ost sty!e if canal length is inade!uate to retain the post in the canal then the active post should be used #. !utin" a"ent used to cement the post

#esistance Triad@9
Resistance can be achieved by 1. Crown 'e e!1 the bevel is that part of the cro/n margin that e5tends past the post and core margin onto the natural tooth structure. 1 to be effective it should encircle the tooth@#*BdegreesA and ideally e5tend at least 1.)mm onto the tooth structure belo/ the post and core margin . 0ertica! remainin" tooth structure1 leaving as much as natural vertical remaining tooth structure as possible /ill significantly increase the resistance of the final restoration #. *ntirotation1 an oblong or elongated canal orifice can provide the antirotation 1 1. au5illary pins and =ey/ays: prepared in the face of the root

The first feature of the resistance triad is the ferru!e ) The Ferrule is a metal ring or cap intended for strengthening. The /ord probably

originates from combining the (atin for iron @ferrumA and bracelets @viriolaA @Fro/n: 1..#A. &erru!e A ferrum B irio!a <Latin term5 A dental ferrule is an encircling band of cast metal around the coronal surface of the tooth. &t has been proposed that the use of a ferrule as part of the core or artificial cro/n may be of benefit in reinforcing root1filed tooth.

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A protective: or 9ferrule effect; should occur o/ing to the ferrule resisting stresses such as functional lever forces: the /edging effect of tapered posts and the lateral forces e5erted during the post insertion. #osen proposed the concept of an 9e5tracoronal brace; subgingival collar or apron of gold /hich e5tends as far as possible beyond the gingival seat of the core and completely surrounds the perimeter of the cervical part of the tooth. &t is an e5tension of the restoration cro/n: /hich by its hugging action prevents shattering of the root. The collar significantly reduced the incidence of root fracture. To be effective < it must encircle the tooth @#*B BA and ideally e5tend at least 1.)mm onto tooth structure belo/ the post and core margin. 2. 0ertica! remainin" tooth structure ) Traditionally: it /as thought that the face of the root should be flattened prior to the construction of the post and core. >o/ever: it has been sho/n that leaving as much natural remaining tooth structure as possible /ill significantly increase the resistance of the final restoration. 8nfortunately: because of caries: trauma: or iatrogenic removal: vertical remaining tooth structure is not al/ays available. 4. *ntirotation ) Every post D core must have an antirotation feature incorporated in the preparation. An elongated or oblong canal orifice can serve as an antirotation for post and core. >o/ever: as the canal becomes more round: the need for incorporation of antirotation features becomes more important. This is especially true for anterior teeth. Au5illary pins and =ey/ays are prepared in the face of the root prior to construction of the post and are most common antirotation devices.

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&*CTO#S *&&ECTIN3 SELECTION O& POST *ND CO#E S.STEM 1. Root length . Tooth anatomy #. Post /idth '. Canal configuration and post adaptability ). Coronal structure *. $tress +. Torsional force ,. Role of hydrostatic pressure .. Post design 1B. Post material 11. 0aterial compatibility 1 . Fonding ability 1#. Core retention 1'. Retrievability 1). Esthetics

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C-STOM C*ST POSTSE Currently: the clinician can choose from a variety of post system for different endodontic and restorative re!uirement. >o/ever: no single system provides the perfect restorative solution for every clinical situation and it re!uires an individual evaluation. The traditional customs cast do/el core can be made by reliving a plastic sprue /ith acrylic or a metal pin /ith /a5 to form the post. The same material can be used for core formation.

*d anta"es 1. They are custom fit to the root configuration. . Provide a better geometric adaptation to e5cessively flared: elliptical: tapered: noncircular or irregular shape canals. #. E5cellent core retention. '. 2reater strength in the sections. ). This t/o1step procedure improves the marginal adaptation and allo/s for a variation in the path of insertion of the cro/n. *. &t almost al/ays re!uires minimum tooth structure removal +. Custom cast post and cores adapt /ell to e5tremely tapered canals or those /ith a non1circular cross1section or irregular shape: and roots /ith minimal remaining coronal tooth structure Disad anta"es 1. Root fractures 1 the modulus of elasticity of cast metal is 1B times greater than that of dentin leading to greater stress concentration and subse!uent root fracture. . The transmission of occlusal forces thorugh the metal cores can focus stresses at specific regions of the root: causing root fracture '1

. Aesthetics < metal post alter the light transmission through the tooth and may sho/ through the root especially /here the gingiva is thin. a.The corrosion products may pass into the root: discolouring the tooth b. 0etal core /ill also alter the optical properties of overlying ceramic restoration. #. Fiocompatibility < non precious metals sho/ corrosion /ith in the root /hich has been implicated as a cause of root fracture. '. This method re!uires t/o1appointment visits and a laboratory fee. Indications for custom cast $ost 1. 7hen multiple cores are being placed in the same arch1 &t is more cost effective to prepare multiple post spaces: ma=e an impression D fabricate the posts in laboratory. . 7hen post D cores are being placed in small teeth @mandibular incisorsA. &n these circumstances: it is often difficult to retain the core material on the post. #. 7hen the angle of the core must be changed in relation to the post: prefabricated posts should not be bentM therefore: the custom< cast best fulfills this re!uirement. '. 7hen an all1ceramic non1core restoration is placed it is necessary to have a core that appro5imates the color of natural tooth structure. &f a large core is being placed in a high1stress situation: resin composite may not be the material of choice due to the fact that it tends to deform under a load. &n this circumstance: the post D core can be cast in metal: D porcelain can be fi5ed to the core to simulate the color of natural tooth structure.

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P#E&*,#IC*TED POSTS *ND CO#ES The prefabricated do/el may be a metal do/el to /hich a custom core is cast. &t can be a do/el /hich can be cemented into the canal /ith an amalgam or composite core formed around it. Finally: the do/el may be standardi?ed precision plastic pattern to /hich a custom core is added before investing and casting. The principle employed is to ma=e the canal fit the post rather than ma=ing the post fit the canal.

ADVANTAGES OF PREFABRICATED POSTS: $imple to use (ess time consuming $ingle appointment procedure. Easy to tempori?e. Cost effective $trong DIS*D0*NT*3ES O& P#E&*,#IC*TED POSTS) 1 1 1 1 1 Root is designed to receive the post: rather than post being designed to fit the root. Application is limited /hen considerable tooth structure is lost. Chemical reactions are possible /hen post and core are made of dissimilar metals. Attachments for removable prosthesis cannot be applied to post core unless a separate casting is fabricated to be placed over it. (oss of retention of post and core. Considering the ma3or dra/bac=s of the metal post systems @Custom and prefabricated post systemA: researchers have evolved /ith the fiber reinforced composite post systems. These serve to alter not only the procedures: but the very paradigms of treatment. These include 1N 0inimal invasiveness of the remaining post endodontic dentin. The biocompatibility of restorative materials @Posts: cores and cementsA to the remaining natural tooth structures

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 The esthetic compatibility of both the post and the core and easy retrievability. $ome prefabricated post and core systems available are 1$ Prefabricated precision plastic do/el a. parallel b. tapered %$ Prefabricated do/el" cast core $ Prefabricated do/el" composite core 4$ Prefabricated parallel threaded do/el #$ Parallel self threading do/el &$ Amalgam pin core '$ Composite resin core

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3-TT* PE#CH* #EMO0*L

Chemica! remo a! $olvents such as oil of eucalyptus: oil of turpetine and chloroform have been used to soften gutta1percha for removal: /ith the latter t/o being the most efficient. >o/ever: some of these materials and especially chloroform are ha?ardous to use as they are to5ic and potentially carcinogenic. Cil of turpentine is less to5ic: but there is concern that solvents in general lead to a dimensional change in the gutta1percha: leading to increased microlea=age. %isadvantages < 1. difficult to control the depth of softening of the gutta1percha . potential lea=age of the solvents into the periradicular tissues Therma! remo a! A heated instrument such as a lateral compactor can be inserted into the gutta1percha to the desired length to soften and remove the guttapercha. >o/ever: in narro/ canals: fine instruments lose their heat !uic=ly and gutta1percha removal can be difficult. A $ystem F spreader is ideal for removal or gutta1percha. Procedure1 From a pre1operative radiograph a plugger should be chosen of the correct dimensions that is li=ely to bind at the desired post length and this position should be mar=ed on the plugger /ith a rubber stop. The tip should be placed in the gutta1percha and /ith the heat applied driven slo/ly to the desired post length in about 1# seconds. The heat should be removed and the plugger allo/ed to cool: for about +11B seconds: t/isted and then removed /ith the coronal gutta1percha. Alternatively: a short burst of heat to the plugger /ill allo/ for easy removal. &t is important that the plugger is sufficiently hot to completely soften the gutta1percha. &f too cool it /ill result in the gutta1percha remaining stic=y /ith the ris= of dislodging the apical gutta1percha. An instrument such as a Fuchanan plugger can then be used to vertically compact the softened gutta1percha.

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Mechanica! remo a! 0echanical removal of gutta1percha is efficient and probably the most commonly used techni!ue: but it is a techni!ue that can result in the most damage to tooth tissue. &f done incorrectly it can /ea=en the root unnecessarily: damage the periodontium and in some cases lead to root perforation. A non1end cuttingM bur such 2ates 2liden or Peeso reamer should be used for gutta1percha removal: as these /ill cut and remove the relatively softer gutta percha preferentially to the dentine of the canal /alls. The se!uence in /hich the burs are used is be important so that a rise in temperature at the root surface: /hich could damage periodontal cells: is avoided and the ris= of preferentially cutting a/ay root dentine to one side of the root canal is reduced. Temperature rise on the root surface has been investigated in a number of studies. The 2ates12lidden bur rotating at ,BBBrev"min results in a small rise in temperature at the root surface. >o/ever: both tapered and parallel1sided post star drills produce a significant increase in temperature in 1e5cess of 1+OC. Peeso reamers also generate significant rises in temperature: higher than that reached /ith 2ates12lidden burs and Parapost t/ist drills.

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INST#-MENT*TION A /ide variety of instruments can be used for enlarging the root canal for a postE $afe1ended reamers >and file $tandard burs /ith long shan=s. The preparation is begun by placing a hot endodontic plugger appro5imately half the length of the canal. This is follo/ed by the actual post preparation. Peeso reamers or 2ates 2lidden drills are /idely used for preparing the post space. Fegin /ith the largest si?e that /ill fit easily into the canal. Prepare the canal to the complete predetermined length. Then s/itch to the ne5t largest instrument in the graduated series and repeat the process. %o this until the desired diameter has been attained. The instrument is leaned over lightly as it is /ithdra/n from the mouth of the canal. This /ill result in an essential parallel1sided preparation /ith a tapered orifice. 3ates 3!idden dri!! 1 1 1 1 1 a non1cutting tip numbered 11*: range in diameter from B.) to 1.) mm in graduated increments of B. mm. shorter cutting flutes @1.)1'.BmmA instruments measure 1, mm from the cutting end &$C standardi?ation < )B11)B. 1 Cutting portion is smaller and more maneuverable 1 Easier to use in starting very small canals 1 $horter cutting flutes and more fle5ible shafts Peeso reamer 1 1 1 non1cutting tip numbered 11*: range in diameter from B.+ to 1.+ mm in graduated increments of B. mm. (onger cutting flutes @+.)1,.)mmA.

Advantages of using gates glidden drills1

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1 1

instruments measure 1, mm from the cutting end &$C standardi?ation < +B11+B. 1 have a sharp: but noncutting tip: they /ill follo/ the path of least resistance 1 conform more consistently to the original canal in the apical region than /ill other types of instruments

Advantages

Peeso #eamer Si+esE #eamer Num'er 1 Diameter B.+mm B..mm 0andibular incisor 0a5illary first premolar 0a5illary second molar @%FA 0andibular first molar @0(A # 1.1mm 0andibular second molar @0F: 0(A 0a5illary second premolar 0a5illary first molar @0F: %FA 0a5illary second molar @0FA 0andibular first molar @0F: %A '. 1.# mm 0andibular second molar @%A 0a5illary lateral incisor 0andibular premolar ) * 1.)mm 1.+ mm 0a5illary molar @(A Canine 0a5illary central incisor. Teeth

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Custom Post6Core )
Custom post1core can be fabricated in t/o techni!ues E Direct 6 fabricated directly in the mouth on the prepared tooth. Indirect1 utili?es an impression and stone die of the tooth for pattern fabrication. The pattern from either the direct or indirect techni!ue is then invested and cast /ith gold or any other cro/n and bridge alloy.

Direct techni(ue The direct custom post core is made by fabricating a resin or /a5 pattern in the prepared tooth in the patientIs mouth. $ome form of plastic post or thin metal post is used as the central reinforcement around /hich the resin or /a5 pattern is formed. The pattern can be made of /a5 reinforced /ith a plastic rod: a bur: a metal pin or a paper clip. Acrylic resin can also be used for this purpose or /a5 and acrylic can be combined. The use of resin allo/s the pattern to be formed into a /ell adapted solid post that can be manipulated easily in the mouth /ithout becoming distorted or loose in the canal. After removing as much gutta1percha as possible /ith a hot endodontic plugger: begin the actual canal preparation /ith the largest reamer /hich /ill fit into the canal. 0a=e a radiograph to chec= the accuracy of the preparation depth. 8se the radiograph to ma=e any necessary ad3ustments in the reamer length. A =ey/ay is placed in the orifice of the canal to provide anti1rotational stability to the post. Cne or more vertical grooves are cut in the /alls of the canals: e5tending #1' mm do/n the canal. The same effect can be achieved on a multi rooted tooth by placing a short post into a second canal. The =ey/ay should be cut to the depth of the diameter of a No. 1+B bur @nearly 1.B mmA in the area of greatest bul=. A second opposing =ey/ay is placed in larger root. Add a prominent contrabevel to provide a collar around the occlusal circumference of the preparation. &t /ill aid in holding the tooth together and preventing fracture. This

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serves as a safeguard on a precision fitting post: /hich can e5ert lateral forces during cementation. The post1core pattern /ill be fabricated /ith a plastic scre/ and resin . Cnce the preparation is ready for the fabrication of direct pattern: /rap a cotton pellet tightly around a No.1 Peeso reamer and dip it into the duralay lubricant. The cotton should be completely coated /ith the lubricant. &nsert the peeso reamer to the entire length of the post preparation. Then pump the reamer in and out to ma=e sure that the entire canal is /ell coated. $ome of the lubricant should be on the coronal part of the preparation as /ell. 8se 1' gauge plastic sprues for the pattern. They are hard enough to reinforce the pattern and they /ill burnout cleanly. Plastic tooth pic=s are softened by the monomer and often are separated from the pattern during removal. Trim the sprue /ith a garnet disc so that it /ill fit into the canal easily. &t must reach the apical end of the post preparation. Cut a small notch in the facial portion of the occlusal end of the plastic sprue to aid in orienting the pattern in subse!uent steps. Coat the plastic sprue /ith monomer. 0i5 the duralay monomer and polymer to a thin: runny consistency in a dappen dish and fill the mouth of the lubricated canal as completely as possible /ith a plastic filling instrument. Coat the plastic sprue /ith the acrylic /hile it is still fluid. $eat the resin covered sprue in the canal until it has touched the apical end of the post preparation. 0a=e sure that all the e5ternal contrabevel is covered at this time. 0ore resin is added to the coronal portion of the pattern to provide the bul= for the core. &t can be added /hile the post is still polymeri?ing or it can be added as a fresh mi5 to the polymeri?ed post. 7hen the resin on the post itself becomes doughy: pump the pattern up and do/n to prevent its being loc=ed into any undercuts in the canal. Remove the post from the canal and see if it e5tends the full length of the prepared canal. Fill any voids /ith soft utility /a5 and replace the pattern.

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$hape the coronal portion of the pattern to form it into a cro/n preparation for the final restoration. Remove the pattern from the mouth end roughly shape the a5ial surface /ith a garnet disc. Replace it in the tooth from time to time to ensure that the contours being shaped are consistent /ith the remaining coronal tooth structure. Fe sure that the finish line of the final cro/n preparation is on tooth structure and not on the core.

After complete finishing of core pattern: it is cast in gold or nic=el <chrome alloy. The core portion of the casting should be smoothened to a satin or matte finish. 8se a carbide noE#' bur to cut a -1shaped cement escape vent on the side of the post. This groove should help greatly to prevent damaging lateral stresses during cementation. 7hile using the hard nic=el1chrome alloys: this tas= can be made easier and faster by placing the groove in the acrylic pattern and retouching it in the finished casting.

Prepare a thin mi5 of ?inc phosphate cement and insert some into the mouth of the dried: isolated canal. Cover the blade of the instrument /ith cement a second time and hold it incisal to the mouth of the canal. &nsert slo/ly rotating lentulo spiral paste filler through the mass of the li!uid cement to carry the cement into the canal. Apply more cement to the mouth of the canal until no more /ill move into the canal.

(iberally coat the post /ith the fluid cement and insert the post into the canal. $eat the post slo/ly /ith finger pressure: allo/ing the cement to escape ahead of the post. &f the incisal edge of the core is uncomfortable against the finger: cushion it /ith a cotton roll. Never mallet the post to place. The close fitting hydraulic chamber formed by a custom post moving through a viscous li!uid in a parallel /alled canal can produce considerable stress in the lateral /alls of the tooth: and fracture could result.

7hen the cement has set : go over the a5ial surfaces of the core and tooth structure /ith a fine grit diamond as it is important to remove any minor undercuts in the a5ial surfaces near the margin of the post1core. &f allo/ed to remain: any defects in the a5ial surface could present obstacles to the successful completion of the final restoration.

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The tooth can no/ be restored /ith a cro/n. The portion of the coronal tooth form that has been built up /ith the core can be treated as though it /ere tooth structure /hen the final restoration is fabricated.

Post space preparation

Fabrication of 7a5 pattern

Indirect techni(ue A custom post1core can also be fabricated by ma=ing /a5 or resin pattern on a cast of the prepared tooth. An impression can be made by in3ecting impression material into the canal and then using a lentulo spiral paste filler to ensure the elimination of entrapped air and voids in the impression of the canal. The impression is reinforced /ith some type of rigid post. The items that have been used for this purpose are paper clips: short lengths of /ire: plastic sprues: and a root canal instrument. These reinforcing devices not only strengthen the impression /hen it is made: but also /hen it is poured and separated. A custom acrylic post can also be made in the tooth to serve as the impression of the canal in transferring it to a cast for fabrication of the core and restoration. 7hen the indirect techni!ue is used /ith one of the prefabricated precision plastic patterns: a post pattern is placed into the canal: and it is pic=ed up in the impression. The post then creates its o/n space in the cast /hen the impression is poured. 7hile any impression material /ith /hich the operator is familiar can be used: light body elastomeric materials /hich are more fle5ible is preferred. Cnce the cast is poured: a removable die should be fabricated. The cast is mounted in a %i1(o= tray. This permits the use of a removable die /ithout any possible

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interference bet/een a post pin on the bottom of the die and the post core preparation deep /ithin the die. The /a5 pattern can no/ be fabricated on the die and /or=ing cast. (ubricate the die copiously /ith a die lubricant. 0a=e sure the post preparation is /ell filled. %ead soft:1 gauge round /a5 forms can be used to form the post. &t is placed into the bottom of the canal in the lubricated die. Cut it off flush /ith the top of the coronal tooth structure /ith a sharp laboratory =nife. 2rasp a piece of /ire such as a straightened paper clip in cotton pliers and heat it in the flame of a Funsen burner. Plunge the hot /ire into the canal until it touches the bottom: melting all the /a5 in the canal. >old it steady until the /ire cools and the /a5 solidifies. 2ently pump the /ire and soft /a5 post in and out a fe/ times to ma=e sure that it is easily removable from the die. 8se regular inlay /a5 to build up the core portion of the /a5 pattern. Finish the margins of the core /ith a /arm beaver tail burnisher to produce as /ell fitting a casting as possible. The completed /a5 pattern /ill have the paper clip protruding from the incisal edge or lingual surface. The /ire /ill serve as the main support of the sprue. $oft /a5 is added to the /ire to thic=en it to the diameter of a 1B or 1 gauge sprue. &nvesting and casting can be done in the regular /ay. Place the completed post 1core in the die: ma=ing sure that it is completely seated. Relubricate the die and lubricate the core. Then /a5 a coping for the porcelain fused to metal cro/n. $eat the cast coping bac= on the post core in the die. The marginal adaptation should be good and the fit of the coping over the post core and die should be passive: i.e.: there should be no binding.

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Porcelain fused to metal restoration is fabricated.

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C-STOM DO>EL CO#E <T>O PIECE5 ) >o/ever: if a severely damaged tooth is to be sub3ected to the stresses of acting as an abutment for a fi5ed bridge or removable partial denture: more resistance and retention are re!uired. Fecause of the root divergence found in most molars: using a do/el1core /ith t/o or three parallel do/els e5tended into multiple roots can be !uite ha?ardous. Therefore a multi1piece do/el core /ith separate do/els should be employed. The do/el1core for a mandibular molar is usually divided into mesial and distal segments. The ma5illary molar do/el <core is composed of facial and lingual components /ith the do/els in the t/o facial canals paralleling each other. 7hen the mesiofacial and distofacial canals are too divergent to permit parallel do/els: a separate third do/el is re!uired. For a t/o piece do/el1core to achieve ma5imum strength and retention from the do/els in divergent canals: the pieces must be rigidly bound together after insertion. A number of indigenious methods have been proposed for accomplishing this. The core can be made in t/o halves: held together by interloc=ing lugs: /hich can be formed from a commercially available non1rigid connector pattern or by cutting a =ey/ay or dovetail in one half of the core pattern. A commonly used solution for the problem is the fabrication of the core /ith an integral do/el and a channel in the core through /hich an accessory do/el is cemented. The hole for the interloc=ing accessory do/el is aligned /ith a preparation in another diverging canal. The accessory do/el acts as a do/el1core /ithin a do/el1core and its divergent direction helps to nail the core in place. The secondary do/el can be a prefabricated post or /ire: or it can be a cast custom do/el. A variation on this theme uses a core /ith no attached do/el. &t is pierced /ith channels for t/o or three diverging separate do/els /hich: /hen inserted and cemented: /ill hold the core firmly in position. Finally the core be fabricated in t/o halves /ith pin holes in the first half and interloc=ing pins in the second half. The core is pinned together /hen both halves have been cemented in the tooth.

)*

Any of these interloc=ing methods can be fabricated by the direct techni!ue or by the indirect techni!ue of /hich the latter techni!ue seems to be far more e5peditious and simple. &n indirect techni!ue: it is important to obtain an accurate impression of the canal preparation. A short segment of /ire @paper clipA is placed in each canal to reinforce the impression do/el . Cnce the cast is ready: the /a5 pattern for the facial half of the do/el core /ill be fabricated first. Cn a mandibular tooth: it /ould be mesial half. 2auged: plastic sprues are tried into the t/o facial canals. Trim them /ith coarse garnet discs so they /ill fit easily to the bottom of their respective do/el preparation. After sufficient lubrication: place soft round /a5 forms into each of the t/o facial canals. Cut them off flush /ith the root face of the tooth. Plunge a hot P6T no.1 instrument to the bottom of each of the canals: melting the soft /a5 completely. 7hile the /a5 in the facial canals is still soft: insert the trimmed solid plastic sprues into the /a5 and shove each of them to the bottom of its respective canal. To provide the loc=ing mechanism for tying the t/o halves of the core together after cementation: pin holes are drilled in the facial half of the core. The facial half of a core is then produced. The e5ternal a5ial contours of the facial half /ill be consistent /ith the a5ial /alls of a full cro/n preparation. The lingual surface /ill be flat smooth surface: /hich parallels the path of insertion of the palatal canal. 8se an enamel hatchet for core and 1.) mm /ide ledge or shoulder in the occlusal third of the lingual surface. Carefully align a B.+ mm drill /ith the path of insertion of the palatal canal. %rill the pin holes in the ledge: ma=ing them parallel /ith each other and the path of insertion of the palatal canal. For ma5imum effectiveness: they should e5tent the full length of the core. A short section of thin pencil lead is placed in each pinhole before investing. This /ill =eep the holes patent during burnout and casting. About mm of graphite

)+

should sho/ at each end of the pin hole to ensure that the rods /ill be held securely by the investment. The pattern is invested: burned out: and cast .A gold alloy should be used because graphite rods are employed to maintain the pin holes. The contamination of a chromium containing alloy /ith carbon /ill increase brittleness and decrease corrosion resistance. 8se the B.+ mm drill to remove the graphite from the pin holes. Cnce the casting for the facial half of the do/el core has been fabricated: the lingual half can be made against it on the cast. $eat the completed facial of the do/el1core into the facial canals. Chec= to ma=e sure that the lingual surface and the t/o pin holes are parallel /ith the do/el preparation in the palatal canal. &nsert nylon bristles into each of the pin holes and lubricate the lingual surface of the facial core. Relubricate the palatal canal profusely. Try a 1' gauge plastic sprue into the palatal canal. Trim the sides of the spring /ith a coarse garnet disc to allo/ the sprue to slip easily to the bottom of the canal. 7a5 or acrylic resin can be used to build the pattern. A fresh mi5 of resin is placed in the mouth of the canal: and the trimmed plastic sprue is seated to place. 7hen the acrylic is near polymeri?ation: pump the sprue in and out several times to ensure that it /ill not loc= into any undercuts. 8se a second mi5 of acrylic to build1up the re!uired bul= for the lingual half of the core. The resin should surround the nylon bristles pro3ecting from the facial core: and it should overlay the occlusal aspect of the facial core. 8se garnet discs and carbide burs to shape the a5ial contours and occlusal planes of the lingual core. The core should no/ resemble a tooth preparation for a full cro/n. 8se inlay /a5 to touch up any voids in the acrylic pattern. 0argins should be /ell adapted and a5ial surfaces should be free from undercuts. After the lingual half is invested and cast: finishing is done /ith abrasive discs and rubber /heels.

),

The t/o halves of the do/el core are assembled in the /or=ing cast to ensure that they /ill fit together in the tooth. The t/o piece do/el 1core is no/ ready to be cemented in the tooth to rebuild it for placement of the final restoration. The facial half /ill be cemented first follo/ing immediately by the lingual half .Cn a mandibular tooth the mesial /ould be first: follo/ed by the distal.

Cut a v1shaped cement vent do/n the length of each do/el to assist complete seating and the prevention of damaging stresses. The cemented do/el1core is no/ ready for completion. The finish line is touched up /ith a chamfer diamond to provide space for the bul= of metal ad3acent to the acute margin in the final cro/n. The margin of the final restoration /ill be placed on solid tooth structure to provide a marginal seal and to provide a band of reinforcing metal apical to the core

).

C*-SES &O# &*IL-#E O& MET*L POST S.STEM

The failure of post retained cro/ns has been documented in several studies as1 1 $econdary caries 1 Periradicular pathosis 1 Periodontal disease 1 Post dislodgement 1 Cement failure 1 Post1 core separation 1 Cro/n 1core separation 1 (oss of cro/n retention 1 Corrosion of metallic posts 1 Core fracture 1 Post distortion 1 Root fracture

*B

(oss of final restoration

(oss of retention of the post due cementation failure

Fending at the post core interface

Fracture at post core interface

Fracture of the tooth *1

(oss of retention of the post due to inade!uate length

P#E&*,#IC*TED DO>ELS *ND CO#ES Prefabricated do/els and core combinations are an appropriate choice for most clinical situations: particularly for posterior teeth. Though there are many variations: most systems contain preformed metallic do/elPs corresponding to the instrumentation used in refining the do/el space. 1. Prefabricated Precision Plastic %o/el a. Parallel b. Tapered . Prefabricated %o/el Cast core. #. Prefabricated %o/el Composite resin core. '. Prefabricated Parallel Threaded @PretappedA %o/el. ). Parallel $elf1Threading %o/el. *. Tapered $elf1Threading %o/el. +. Amalgam Pin core. ,. Composite resin Pin core. P#E&*,#IC*TED P#ECISION PL*STIC DO>EL The fabricated precision plastic do/el forms part of a system in /hich the do/el is designed to fit a canal space shaped by a specific instrument of matching si?e and configuration. This differ from the custom do/el core because the canal is prepared to fit the do/el rather than a pattern being made as an impression of the internal aspect of the tooth. Precision plastic do/els are available in t/o configurationsE Parallel Tapered.

P#ECISION P*#*LLEL PL*STIC DO>EL Parallel do/els e5hibit superior retentionE studies have found them to be 1.. times: #.# times: and '.) times as retentive as prefabricated tapered do/els of e!ual length. &f the surface is. serrated: retention /ill be improved even more. Para $ost Para Post is a prefabricated

precision serrated surface /ith a parallel sided geometry. &t is designed to be used /ith one or more parallel pins set in dentin peripheral to the canal. The pins act primarily as antirotational features: although they may add some retention and resistance to do/el cores /hich are lac=ing those !ualities because of tooth si?e or morphology. Conditions that permit the use of a serrated parallel plastic do/el pattern include a fairly bul=y root and a canal: /hich is essentially straight. Fecause a parallel do/el does not follo/ the natural taper of most roots: it may not be possible to choose a pattern and drill for every tooth. The do/el pic=ed must be large enough to leave an ade!uate thic=ness of dentin at the apical end. &f the coronal portion of the canal has been enlarged e5cessively: a small do/el may fit too loosely: and a larger do/el may cause insufficient tooth structure to be left in the apical portion. &n considering a tooth for restoration /ith this system: it is also necessary to evaluate the tooth structure available for pin placement. &f there is insufficient bul= to accommodate pins: =ey/ays can be prepared in the /alls of the canals. The most important factor in the retention of a precision parallel do/el: as /ith any do/el: is length. $ince no part of the do/el preparation developed by the standard Para Post drill is rounded over or tapered: the do/el space tends to come closer at its apical e5tension. An assessment of the length of the do/el space should ta=e this into account. The do/el should be at least as long as the clinical cro/n of the tooth: or as long as possible /ithout encroaching on the apical ' mm of the endodontic filling

*#

Color coded plastic posts are available in diameters ofE 1. ) mm @redA 1.)B mm @blac=A. 1.+) mm @greenA %iameters of B.. mm and 1.B mm can also be obtained. There is a paralleling 3ig for each of the diameters to be used in con3unction /ith a B.+ m Parama5 drill. Plastic pins are used for an impression if the indirect techni!ue is employed: and iridoplatinum pins are used in the direct techni!ue for the /a5 pattern and casting done

*'

P#ECISION T*PE#ED PL*STIC DO>EL 0ost of the precision plastic do/el systems: /hich are mar=eted today: are tapered: /ith the taper ranging from 1.1B to *. Q. $ome authors advocate the use of a taper because it more nearly appro5imates the tapered configuration of roots: thereby lessening the chance of a lateral perforation during do/el preparation. To match the tapered plastic pattern to the do/el preparation /ith accuracy: it may be necessary to cut a little length from the small end of the pattern: or reinstrument the canal to enlarge it slightly: depending on /hether the do/el is too loose of too tight. This must be done /ith great care: comparing the depth of the do/el preparation and the length of the do/el pattern. Cther /ise: it is possible to /edge a tapered do/el into the canal: ma=ing contact /ith its /alls short of full seating of the do/el. The operator may misinterpret the slight Ptug bac=P that he feels as a manifestation of an accurate fit. The use of a tapered precision plastic do/el /ith a matched reamer of same si?e obviates the need for relining the do/el in the canal /hen the do/el core is fabricated. The most commonly used tapered plastic do/el areE a. Endo/el $ystem. b. P1% Posts. c. Coloroma =it. d. Calibrated &nstrumentation =it. ENDO>EL S.STEM This system has smooth do/el patterns that are matched to hand instruments i.e the standardi?ed endodontic files and reamers. Therefore: they e5hibit 1.1 Q taper of standardi?ed endodontic instruments. The do/els are available in eight si?es. $i?e 1 1 +B @B.+ 1 B.. mmA $i?e 1,B @B., 1 1.B mmA

$i?e # 1 .B @B.. 1 1.1 mmA $i?e ' 1 1BB @1.B 1 1. mmA $i?e ) 1 11B @1.1 1 1.# mmA $i?e * 1 1 B @1. 1 1.' mmA

*)

$i?e + 1 1#B @1.# 1 1.) mmA $i?e , 1 1'B @1.' 1 1.* mmA &n each pair of numbers: the first designates diameter at the tip: /hile the second represents the diameter 1B1mm from the tip. P6D POSTS These are smooth sided plastic do/el patterns /ith a uniform convergence angle of 1.*Q. The do/el space is prepared /ith reamer of li=e taper and diameter. Each reamer has an ad3ustable sliding metal stop that is held in place /ith a set scre/. The patterns are available in si5 si?es. $i?e 1 1 B.. 1 1.# mm $i?e 1 1.1 11.) mm $i?e # 1 1.# 1 1.+ mm $i?e ' 1 1.) 1 1.. mm $i?e ) 1 1.+ 1 .1 mm $i?e * 1 1.. 1 .# mm. COLO#OM* KIT There are five si?es of patterns in the Coloroma =it. The smooth sided do/el patterns are actually a combination of tapered and parallel sided: /ith the tapered portion increasing in length from ) mm of the smallest do/el to . mm on the largest. The tapered portion has a convergence angle of *. Q. The do/el preparations are accomplished /ith a color coded engine reamer of a matching si?e: /hich is tapered near the tip and parallel sided ad3acent to the shan=. $i?e 1 1 B., mm 1 1.# mm $i?e 1 B.. mm 1 1.' mm $i?e # 1 1.B mm 11.* mm $i?e ' 1 1.B mm 1 1., mm $i?e ) 1 1.1 mm 1 .B mm

**

THE C*LI,#*TED.INST#-MENT*TION <C.I5 KIT This =it consists of three rotary instruments. The do/el preparation is begun /ith a bibevel t/ist drill. 7hen the initial channel has been prepared: it is enlarged /ith a pointed reamer. The final diameter and taper is achieved /ith a tapered fissure bur /hose si?e and taper match those of do/el pattern. The smooth sided patterns have a taper of .*B and they are available in t/o si?es. $i?e 1 1 1.B mm 11.# mm $i?e 1 1. mm 1 1.* mm The t/o numbers in each set indicate the diameter at the tip and 1B mm from the tip. There is a separate set of instruments for each do/el si?e. To match the tapered plastic pattern to do/el preparation /ith accuracy: it may be necessary to cut a little length from the small end of the pattern: or reinstrument the canal to enlarge it slightly depending on /hether the do/el is too loose or too tight. P#E&*,#IC*TED MET*L DO>EL6C*ST CO#E Another approach to the fabrication of do/el cores has been one in /hich a precision made prefabricated do/el is matched in si?e to a bur or hand reamer. After the do/el preparation is completed: the prefabricated do/el is fit in the canal. A core is then made of resin or /a5 by the direct or indirect techni!ue. The metal do/el and its core pattern are invested: and the core is burned out. Then the core is cast in metal. The use of a prefabricated metal do/el /ith a cast core offers the advantage of having part of the do/el core already completed before the procedure is even begun. &t has also been promoted because of the superior strength of a /rought or dra/n do/el compared /ith a cast one)*: especially /hen the do/el is less than 1.) mm in diameter. The prefabricated do/els have been made of a variety of materials including gold: gold1platinum1palladium: iridoplatinum: platini?ed /ire: nic=el1cobalt1chromium and stainless steel. The core can be fabricated by the direct or the indirect techni!ue. The commonly used system is the Endopost /hich utili?es a noble metal smooth tapered do/el /hich is matched to the standard used endodontic hand f1les and reamers. The Endopost system utili?es a noble metal do/el /hich e5hibit the slight taper of the

*+

standardi?ed endodontic instruments. &t is available in eight si?es /hich matches the si?e of the endodontic files $i?e 1 1 No. +B @B.+ 1 B.. mmA $i?e 1 No. ,B @B., 1 1.B mmA $i?e # 1 No. .B @B.. 11.1 mmA $i?e ' 1 No. 1BB @1.B 1 1. mmA $i?e ) 1 No. 11B @1.1 11.# mmA $i?e * No. 1 B @1. 1 1.' mmA $i?e +1 No. 1#B @1.# 1 1.) mmA $i?e , No 1'B @1.' 1 1.* mmA A resin core is fabricated around the incisal end of the prefabricated do/el /hich e5tend from the tooth. The do/el can also be used for ma=ing an impression of the do/el in order to fabricate the core indirectly.

P#E&*,#IC*TED DO>EL%COMPOSITE #ESIN CO#E Perhaps the simplest and most efficient method for the fabrication of a do/el core restoration is the composite resin core in combination /ith a prefabricated stainless steel do/el core. The entire procedure from completion of the endodontic obturation through the finished cro/n preparation: can be accomplished in a single appointment. This system can be used succesfully in a /ide range of clinical situations. At one e5treme: this type of do/el has been sho/n to significantly strengthen teeth /ith no coronal destruction other than the endodontic access preparation. At the other end of the spectrum: the prefabricated do/el" composite core can be used to restore both anterior and posterior teeth that have little or no intact coronal tooth structure. Composite resin is easily and !uic=ly placed as a core material: and it has the added advantage of being completely polymeri?ed /ithin minutes: allo/ing /or= on the core preparation to progress immediately. Preparations on amalgam cores: on the hand: often must be delayed until a subse!uent appointment. &n addition: the resin re!uires less bul= of core material: ma=ing it the material of choice for anterior teeth /here there is often minimal space around the do/el.

*,

The prefabricated do/el composite core is ade!uate for the restoration of single anterior tooth. >o/ever: most anterior bridge abutments should have cast do/el1cores. Cn molars /ith e5cessive destruction of coronal tooth structure or /ith very deep finish lines: amalgam may be the material of choice rather than the composite resin core. The do/el portion of the do/el composite resin core acts to resist any lateral forces placed on the cro/n. Care is ta=en to e5tend the finished lines for the final restoration /ell belo/ the composite resin core. 7hen this is done: the cro/n /ill grasp the tooth: creating a PferruleP effect to resist any vertical forces. Au5iliary pins are used routinely to resist any rotational forces placed on the restoration. &n addition: there is some evidence that pins embedded in core material across a tooth may have a Pbuttressing effectP and resist splitting forces on the root. The prefabricated do/el composite core can also be used to restore a previously cro/ned tooth that has been endodontically treated. The head of the do/el is trimmed to fit /ithin the confines of the access preparation and the do/el is cemented. The space around the head is then restored /ith amalgam or composite. The prefabricated do/el systems used areE 1. C& @Calibrated instrumentA =it . Coloroma =it. #. P.% Cro/npost sytem. '. Para Post system. ). FC> system. *. Ellman Nubond Fast posts. C*LI,#*TED INST#-MENT <C.I5 KIT This =it consists of three rotary instruments. The do/el preparation 1 is begun /ith a bibevel t/ist drill. 7hen the initial channel has been prepared: it is enlarged /ith a pointed reamer. The final diameter and taper is achieved /ith a tapered fissure bur /hose si?e and taper match those of do/el pattern. The corrugated stainless steel do/els have a taper of .*B and they are available in t/o si?es. $i?e 1 1 1.B mm 11.' mm $i?e 1 1. mm 11.+ mm

*.

The t/o numbers in each set indicate the diameter at the tip and 1B mm from the tip. There is separate set of instruments for each do/el si?e. COLO#OM* KIT Coloroma do/els /ere meant to use for fabricating temporary cro/ns: but they can be used /ith au5iliary pins and composite resin cores. There are five si?es of patterns in the coloroma =it. The smooth sided do/el patterns are actually a combination of tapered and parallel sided: /ith the tapered portion increasing in length from ) mm of the smallest do/el to . mm on the largest. The tapered portion has a convergence angle of *. Q. The do/el preparations is accomplished /ith a color coded engine reamer of a matching si?e: /hich is tapered near the tip and parallel sided ad3acent to the shan=. $i?e 1 1 B., mm 1 1.# mm $i?e 1 B.. mm 11.' mm $i?e # 1 1.B mm 11.* mm $i?e ' 1 1.B mm 11., mm $i?e ) 1 1.1 mm 1 .B mm P6D C#O>N POSTS These are stainless steel serrated do/el patterns /ith a uniform convergence angle of 1.*Q. The do/el space is prepared /ith reamer of li=e taper and diameter. Each reamer has an ad3ustable sliding metal stop that is held in place /ith a set scre/. The patterns are available in si5 si?es. $i?e 1 1 B.. 1 1.# mm $i?e 1 1.1 1 1.) mm $i?e # 1+ 1.# 11 1.+ mm $i?e ' 1 1.) 11.. mm $i?e ) 1+ 1.+ 1 .1 mm $i?e * 1+ 1.. 1 .# mm.

+B

P*#* POST S.STEM This is a serrated: parallel sided: stainless steel do/el /hich is used /ith a large color coded t/ist drill of matching si?e. The do/els are available in five diametersE $i?e 1 1+ B.. mm. $i?e 1+ 1.B mm. $i?e # 1+ 1. ) mm. $i?e ' 1+ 1.)B mm. $i?e ) 1+ 1.+) mm. Au5iliary pin holes for minim pins are placed in the root face /ith a. B.) mm 6ode5 drill. Para Post is also available in a tapered end parallel sided do/el. ,CH S.STEM This system is comprised of t/o or three lengths in each of five diameters: for a total of 1' si?es. They are meant to be used /ith peso reamers and come in the follo/ing diametersE Type & 1+ B.,mm Type && 1+ 1.B mm Type &&& 1+ 1. mm The do/el are serrated and parallel sided: /ith tapered tips and a round button on the occlusal end. ELLM*N N-,OND &*ST POSTS These are serrated stainless steel posts /ith a 1.*Q taper. The canal is prepared /ith tapered reamers of matching si?es. There are $i5 $i?esE $i?e & 1+ B.. 1 1. mm. $i?e && 1+ 1.1 1 1.' mm. $i?e &&& 1+ 1.# 1 1.* mm. $i?e &- 1+ 1.) 11., mm. $i?e - 1+ 1.+ 1 .1 mm. $i?e -& 1+ 1.. 1 .# mm

+1

TH#E*DED DO>ELS P*#*LLEL TH#E*DED DO>EL <P#ET*PPED5 This do/el employs threads on its parallel sides for retention and it is inserted into a canal /hose /alls are prethreaded /ith a special tap. &t differs from other types of do/els: because it is not passively inserted into the canal and held in place entirely by the cement. 7hether this threaded do/el is retained by mechanical interaction: or simply by increasing the surface area t/o or threefold: it demonstrates superior retention to other types of do/els. &t /as found to be to #.' times as retentive as parallel serrated do/els in one study: and ) times as retentive in another. Threaded do/els are not /ithout controversy: ho/ever. Concern has been e5pressed over increasing the potential of root fracture by threading do/els into the canal. The stresses generated by threaded do/els are greater than those generated by do/els retained by cement alone. >o/ever: mechanical testing has sho/n that /hen the tap is used properly: fracture cannot be induced. Fre!uent cleaning of the tap is essential to reduce stress and prevent resultant root fracture. The commonly used parallel threaded do/els @pretappedA areE Cro/n anchor. 6urer fin loc= 6urer Cro/n $aver C#O>N *NCHO# The original cro/n anchor consists of a stainless steel threaded shan= @do/elA /ith a slotted machine brass head @coreA. The canal is enlarged /ith an elongated engine reamer: and its orifice is countersun= /ith a root facer. A tap is then used to thread the canal for insertion of the anchor. K-#E# &IN LOCK The 6urer fin loc= utili?es a threaded Proot face finP or loc= nut to snug against the countersun= root face. A narro/ collar near the slotted end serves as additional retention for the composite resin core: /hich /ill be: added after cementation of the anchor.

K-#E# C#O>N S*0E# The 6urer cro/n saver is s simple threaded do/el that has neither a head nor a loc= nut: and therefore: does not re!uire the use of a root facing instrument. &t consists of a parallel threaded do/el: /hich is cemented: in the canal and serves as the retention for a composite resin build up. P*#*LLEL SEL& TH#E*DIN3 DO>EL This system offers a retentive device: /hich is intermediate bet/een the stainless steel do/el composite resin core and the pretapped parallel threaded cro/n anchor. The retention afforded by this type of do/el: /hose threads are /idely separated and shallo/: is .'H greater than that of serrated stainless steel post of the same si?e. The self threading anchor is 1+H to ')H less retentive than similar si?es of pretapped threaded anchors. As these do/els utili?e threads for much of its retention: it is capable of producing stress in the root. Continuing to thread the anchor after resistance is encountered could result in root fracture or stripping of the threads. &f the do/el ape5 is allo/ed to engage the supporting tooth structure: high apical stresses are generated. >igh stress concentrations /ill develop in the coronal portion of the root if the coronal flanges of the head come in contact /ith the root face. &n order to avoid these problems: it is recommended that the do/el be reversed or Pbac=ed off a half turn /hen slight resistance to threading is felt during cementation. #*DIC *NCHO# The Radi5 anchor utili?es threads for much of its retention. They are made in three diameters @do/el si?e e5clusive of threadsAE Type & 1 1.1 mm Type && 11.#) mm Type &&& 1 1.* mm The anchors consists of a lo/ prof1le retentive: spiral head /ith five ro/s of fms or lamellae /hich retain the composite resin core that is built around it. The

+#

shallo/ threaded spiral on the coronal *BH of the do/el is interrupted by four cement vents /hich run the length of the do/el. The anchor drives the /rench used for threading the do/el into the canal: has four prongs firmly engaging four slots in the sides of the head. The Radi5 Anchor /or=s best in teeth /hose clinical cro/ns have some length and volume. T*PE#ED SEL& TH#E*DIN3 DO>EL This style of do/el has been in use for over )B years. &t is the simplest of all threaded do/els. The use of this type of do/el is the prime e5ample of use of the root canal as the ultimate pin hole. An amalgam or composite resin core is usually fabricated around the do/el after it is cemented. Fecause of its do/el si?e and the bul=y head: self threading do/els are generally restricted to use in molars. &t is fre!uently used on teeth /ith a minimum of coronal tooth structure and multiple divergent canals. The non1parallel relationship adds to it the retentive !ualities of the self threading do/el. &ts most obvious advantage is that do/el core can be placed in a single appointment. The tapered self threading do/el is simple and easy to use. The fact that it engages dentin /ith its threads un!uestionably provides e5cellent retention. >o/ever: this type of do/el also produces high stress concentrations: /ith its /edge li=e action producing stress concentrations more severe than those seen in other types of threaded do/els. Translated into practical terms: there is a danger of crac=ing a root. The danger of root fracture is more acute /hen e5cessive tor!ue is applied: or /hen the do/el is over t/isted. Tor!ure re!uired to seat the do/el increases /ith diameter: but do/el length seems to e5ert no influence. (arger diameter do/els have been observed to cause root fractures: especially in teeth /ith ovoid canals. %o/els /hich are oversi?ed for their prepared canal also represent a ha?ard to the tooth. A do/el that is too large compresses the dentin and increases the ris= of root fracture. %urney and Rosen found that the tor!ue re!uired to insert a tapered: self threading do/el /as appro5imately one fourth of the tor!ue needed to fracture a root e5perimentally. They suggested that these do/els should be turned slo/ly and delicately /ithout leverage. This /ould seem to be an ade!uate safety margin: but clinically it has

+'

not al/ays proven to be so. &t may simply be that this type of do/el has been used in too many poorly selected /ea= roots by careless operators. 7hatever the cause: the recommendation has been made that tapered: self threading do/els be passively cemented in slightly over si?ed canals. &n a slight modification of that techni!ue: Tidmarsh has suggested that a do/el /ith a Psnug: sliding fitP be cemented: engaging the threads no more than a single turn during seating. Tapered self threading do/els have been implicated in corrosion /hich could result in root fracture. Rud and CmnelP)' e5amined '*, teeth /ith vertical or obli!ue fractures and concluded that + H of the fractures resulted from corrosion. &t /as theori?ed that galvanic reactions caused the formation of corrosive products that fractured the teeth. &t is also possible that the teeth /ere fractured at the time of insertion: or subse!uently: /ith the fracture remaining undetected for a ling time. The fracture ho/ever minute /ould permit the free passage of saliva and " or serum into contact /ith the do/el and cro/n: causing corrosion products to be formed after the fracture. Nonetheless: it is recommended that the do/el be e5amined prior to insertion. Confirm that the electroplated gold surface is still intact: protecting the brass body /hich is *BH copper and 'BH ?inc. Further: that portion of the do/el to be placed in the canal should not be cut or prepared. %erand#, recommends that the core be placed during the same appointment at /hich the do/el is cemented. This /ill prevent the cement around the do/el from being e5posed to the fluids of the oral cavity for any prolonged period.

+)

DENT*T-S SC#E> POST The %entatus scre/ post is the most commonly used of this style of do/el. &t is mar=eted in a stainless steel and gold plated brass do/el @*BH copper and 'BH ?incA. %entatus scre/ posts are available in si5 diametersE %& 1.B mm % && 1. mm % &&& 1.# mm %&- 1.)mm % - 1.* mm % -& 1., mm There are four lengths of do/elsE ( & 1 +., mm: ( && 1..# mm: ( &&& 1 11., mm: ( &- 1 1'. mm The head of each scre/ post is s!uare: /ith t/o seating /renches. Cne /rench is designed to fit internally into the head of the do/el to allo/ placement of the do/el in tight areas. &t also permits insertion of a do/el /hose head shape and si?e have been altered. A second /rench fits over the head of the do/el. &t is useful on severely bro=en do/n teeth in /hich the do/el head is unaltered. An amalgam core or composite resin core can be placed over the do/els. The do/el head should not be too close to the outer perimeter of the pro3ected a5ial contours of the prepared core. Neither: should they be closer than 1 .) mm from the opposing occlusion. They should be altered: if necessary. and the space bet/een the t/o heads should also allo/ bul= of core material.

+*

CO#E

The core consists of restorative material placed in the coronal area of a tooth. This material replaces carious: fractured: or other/ise missing coronal structure and retains the final cro/n. The core is anchored to the tooth by e5tending into the coronal aspect of the canal or through the endodontic post. The attachment bet/een tooth: post and core is mechanical: chemical or both as the core and post are usually fabricated of different materials. The remaining tooth structure can also be altered to enhance retention of the core. Although: pins: grooves and channels can be placed in the dentin: these modifications all increase the core retention and resistance to rotation at the e5pense of the tooth structure. &n most cases the irregular nature of the residual: coronal tooth structure and the normal morphology of the pulp chamber and canal orifices eliminate the need for these tooth alterations. 8sing restorative materials that bond to tooth structure enhances retention and resistance /ithout necessitating the removal of valuable dentin. Therefore: if additional retentive or antirotation form for the core is deemed necessary: dentin removal should be =ept to a minimum. Core materia!s) #e(uirements) 1. . #. '. ). *. +. ,. .. 1B. 11. $tability in /et environment Ease of manipulation Rapid: hard set for immediate cro/n preparation Natural tooth color >igh compressive strength >igh tensile strength >igh fracture toughness (o/ plastic deformation &nert @no corrosionA Cariostatic properties Fiocompatibility

++

1 .

&ne5pensiveness.

Materia!s used) 1. Cast gold . Amalgam #. Composite resin '. 2lass ionomer ). R02&C

+,

*!ternati e $re fa'ricated $ost and core systems uti!i+in" materia!s a ai!a'!e) (uintessence International 1998, %9: !#" 1% Application of selected criteria @FiomechanicalA to evaluate core materials for pre fabricated post and core systems (($I$ 1998) %9: !#" 1%)

Resin composite Amalgam 2lass ionomer Ease of use

Resin composite 2lass ionomer Amalgam Settin" time

Amalgam Resin composite 2lass ionomer Stren"th

CO#E M*TE#I*L

%imensional stability Amalgam 2lass ionomer Resin composite

0icrolea=age

Fonding mechanism Resin composite 2lass ionomer Amalgam

Amalgam 2lass ionomer Resin composite

+.

C*ST 3OLD) Type &&& and Type &- cast gold alloys are used. *d anta"es) 1. Cffers good strength . Resistance to lea=age derived from luting agent #. %oes not absorb /ater '. close to that of dentin. destruction to be used. Disad anta"es) 1. Time consuming . E5pensive *M*L3*M) 0aterial of choice in high stress situations *d anta"es) 1. $imple to use . Radiopa!ue #. >igh compressive strength D fracture toughness in both static D dynamic loading. '. >igh contrasting color to the tooth ). %imensionally stable *. Antimicrobial +. Acceptable long1term performance as documented in the literature. Disad anta"es) 1. >igh thermal conductivity . >igh co1efficient of thermal e5pansion than the tooth #. %oes not adhere to the tooth substance '. (o/ early strength <re!uires separate appointment for cro/n preparation ). %ar= color of Amalgam < potential to lo/er the value of all < ceramic restorations causing a gray halo at the gingival margin. ). Cast gold buildups re!uire post for retention and substantial degree of coronal

,B

COMPOSITE #ESIN)Possess satisfactory physical properties for core buildup material. *d anta"es) 1. Reliable bond to tooth structure . Command set nature < allo/s immediate cro/n preparation #. Ade!uate fracture toughness D compressive strength in static D dynamic loading. Disad anta"es) 1. >igh coefficient of thermal e5pansion < potential for microlea=age . Not dimensionally stable in /et environment #. 7ater sorption < absorbs /ater K core e5pands: composite dries K core shrin=s. 3L*SS IONOME# CEMENT) used in posterior teeth /ith more than )BH of tooth structure remaining. *d anta"es) 1. Adhesion . Fluoride release #. Co1efficient of thermal e5pansion similar to tooth '. Radiopa!ue ). Contrasting color to tooth Disad anta"es) 1. (o/ compressive strength and fracture toughness . (o/ fle5ural strengths. #ESIN MODI&IED 3L*SS IONOME# CEMENT) Ne/est available core material. *d anta"es) 1. Adhesion . Fluoride release #. Easy to manipulate '. &ntermediate physical properties < lie bet/een 2&C and composite resin. Disad anta"es) (o/ fle5ural strength and fracture toughness -olume in stability < severe e5pansion during initial setting reaction.

,1

CEMENT*TION %o/el and core materials have changed much in recent years. The ability to bond to dentin has significantly e5panded. The options available to the restorative dentist has altered every phase of do/el and core restoration. %o/el can be cemented /ithE 4inc phosphate cement Polycarbo5ylate cement. 2lass ionomer cement. Resin Composite cements Resin modified 2lass &onomer The general cementation procedures for insertion of do/el and core restorations are very similar: regardless of cement type. Cnce mi5ed: the cement is delivered to the do/el space /ith a lentulo spiral: to ensure that all /alls are coated. At the same time: the do/el and core are coated /ith a thin layer of cement. Retention is greatest /hen both the do/el and the root are coated: rather than either alone. The restoration should slide slo/ly and easily into place /ith light finger pressure. E5cess cement must escape coronally as the do/el nearly fills the do/el space. Cnce the restoration is fully seated: it should remain untouched until the cement has passively set. L-TIN3 *3ENTS DINC PHOSPH*TE CEMENT 4inc phosphate cement sets by an acid base reaction initiated on mi5ing a po/der composed of .BH 4nC and 1BH 0gC /ith a li!uid that consists of appro5imately *+H phosphoric acid buffered /ith aluminum and ?inc. The /ater content @##HA is significant because it controls the ioni?ation of the acid: /hich in turn influences the rate of the setting reaction. This is important to the clinician because an uncapped li!uid bottle /ill permit loss of /ater resulting in retarded set. 7ater evaporation should be suspected if the li!uid appears cloudy on dispensing. 4inc phosphate cement has been in use for more than .B years. &fR properly mi5ed: the cement e5hibits ade!uate mm thic=ness to comply /ith A%A specification No ,. The mi5ing techni!ue is critical in developing the optimal cement and should be completed on a cool slab: over a /ide area: to incorporate small increments of po/der into the li!uid

for appro5imately R1 minute and #B seconds. The post should be seated promptly after mi5ing the cement: because the viscosity of most cement is =no/n to increase rapidly /ith time. Cptimal cro/n seating re!uires proper mi5ing and a constant heavy cementation force. The cement strength is almost linearly dependent on the po/derE li!uid ratioM thus: the more po/der the better strength. Compressive @,Bto 11B 0paA and tensile strengths @) to +0paA of properly mi5ed ?inc phosphate are ade!uate to resist masticatory stress. The set cement is e5tremely stiff and e5hibits a high modulus of elasticity of 1# 2pa: /hich permits the cement to resist elastic deformation in regions of high masticatory stress or in long span prostheses. 4inc phosphate does not chemically bond to any substrate and provides a retentive seal by mechanical means only. Thus: the taper: length and surface area of the tooth preparation are critical to its success. $everal studies have demonstrated significant linear penetration of silver nitrate from the e5ternal margin along the restoration tooth interface after cro/n cementation. 0icrolea=age: aggravated by degradation in oral fluids and an initial lo/ setting p>: may affect its biocompatibility in clinical use. Cf utmost importance: ho/ever: is the long clinical trac= record of this cement. &ts inherent stability /as reported in a study that analy?ed the chemical structure of ?inc phosphate cement samples obtained from + fi5ed prostheses that /ere in clinical service from to '# years. 7hereas a fresh: ', hours 1 old cement contained mainly amorphous ?inc phosphate and unreacted ?incP o5ide and phosphoric acid: older cements /ere found to be profoundly chemically stable over time. The proven reliability of this cement validates its use in long term luting of /ell1 fitting: prefabricated and cast posts: metal inlays: onlays: cro/ns: FP%s: and aluminous all ceramic cro/ns to tooth structure: amalgam: composite or glass ionomer core buildups. POL.C*#,OC.L*TECEMENTS Polycarbo5ylate cements: first introduced in the 1.*Bs: set by a fast acid 1 base reaction that occurs /hen ?inc o5ide and magnesium o5ide po/ders are rapidly incorporated into a viscous solution of high molecular /eight polyacrylic acid. Fortunately: these cements e5hibit thi5otropic or pseudoplastic behavior /here an apparently viscous mi5 flo/s readily under pressure. >o/ever: they e5hibit an early:

,#

rapid increase in f1lm thic=ness that may impede the proper seating of a casting. %uring setting: the cement passes through a rubbery stage and at this time: it should remain undisturbed to prevent it from being pulled a/ay from under the margins. Polycarbo5ylate cements have lo/er compressive @)) to ,)0paA and higher tensile @, to 1 0paA strengths than ?inc phosphate. Polycarbo5ylate cements are hydrophilic and capable of /etting dentinal surfaces. They e5hibit chemical adhesion to tooth structure through the interaction of free carbo5ylic acid groups /ith calcium. Cne should hypothesi?e that a truly adhesive cement /ould be less susceptible to microlea=age: but studies have sho/n a similar degree of marginal lea=age for both polycarbo5ylate and ?inc phosphate cements. &n addition: their adhesion to tooth structure is reported to be of minor importance for the retention of /ell1 fitting cast restorations: because polycarbo5ylates e5hibit interfacial adhesive failures at the cement 1 metal interface. Cohesive failures: /ithin the cement: /ere noted only /ith film thic=nesses greater than )B"L.m. After hardening: polycarbo5ylate cements e5hibit significantly greater plastic deformation than ?inc phosphate cementM thus: the cement is not /ell suited for use in regions of high masticatory stress or in the cementation of long span prostheses. $ome formulations contain stannous fluoride: but its release of fluoride ion is small /hen compared /ith glass ionomer cement. Perhaps the strongest clinical merit of this cement lies in its reported biocompatibility /ith the dental pulp: /hich could be due to a rapid rise in p> after mi5ing and " or lac= of tubular penetration from the large and poorly dissociated polyacrylic acid molecule. This cement is /arranted for the cementation of single metal units in lo/ stress areas on sensitive teeth. 3L*SS IONOME# CEMENT This cement type is a descendant of the silicate and polycarbo5ylate cements and /as introduced for clinical use as a luting agent in the early 1.B,. The cement sets by Pand acid base reaction bet/een aluminum fluorosilicate glass particles and a li!uid: /hich consists of copolymers of relatively /ea= polyal=enoic acids: including itaconic: maleic and tricarbo5ylic. These acids can also be : free?e1 dried and incorporated into the

,'

po/der component: /hich is then mi5ed /ith /ater to reconstitute the acid: tartaric acid is also present to provide flo/ and increase the /or=ing time. These cements are thought to adhere to tooth structure by formation of ionic bonds at the tooth cement interface as a result of chelation of the carbo5y groups in the acid /ith the calcium and " or phosphoric ions in the apatite of enamel and dentin. They e5hibit higher compressive strengths @.B tB #B0paA than ?inc phosphate cement. $everal studies have reported decreased microlea=age over nonadhesive type cements. >o/ever: some in vitro studies have not confirmed superior retentive potential for glass ionomer /hen compared /ith ?inc phosphate. Cements are available in hand mi5ed and capsulated forms. >and1mi5ed cements often contain more bubbles of larger diameter: /hich may contributed to a decrease in strength. The compressive strength of glass ionomer is higher than polycarbo5ylate and ?inc phosphate cements. >o/ever: their modulus of elasticity is lo/er than ?inc phosphate cementsM than there is potential for elastic deformation areas of high masticatory stress. Previous studies have reported that glass ionomer cements posses lo/ f11m thic=ness and maintain relatively constant viscosity for a short time after mi5ing. This results in improved seaating of cast restorations compared /ith ?inc phosphate cement. >o/ever: lo/ film thic=ness may not be completely advantageous: because microcrac=s have been attributed to thin cement layers /here a homogenous distribution of curing stresses cannot occur. The main dra/bac=s of this cement are tits /ell1documented susceptibility to moisture attac= and subse!uent solubility if e5posed to /ater during the initial setting period. Early e5posure to /ater and saliva contamination has been sho/n to significantly decrease the ultimate hardness of ?inc phosphate and glass ionomer cements. &f the marginal adaptation of the restoration is poor: /ater sorption and dissolution may result in dislodgment of the restoration. Application of petroleum 3elly around the cro/n margin immediately after placement of the cro/n has been suggested as a /ay to prevent moisture contamination of the unset cement. The cement is also susceptible to dehydration: leading to cohesive failure from microcrac= formation /hen teeth /ere not =ept fully hydrated. &t /as suspected that crac=ing occurred because of stress

,)

concentrations as /ater /as dra/n out of the setting cement. This finding underscores the need to maintain some level of dentin hydration during cementation procedures. The initial lo/ setting p> of glass ionomer /as reported and implicated as a cause for postcementation sensitivity. $ubse!uent studies have disputed this implication. Pulpal in3ury and postcementation hypersensitivity are most li=ely multifactorial and caused irritation from cavity preparation: thin cement mi5 ill 3unction /ith e5cessive hydraulic force: and microlea=agc. Clinical evaluation of restorations cemented /ith ?inc phosphate and glass ionomer cements has reported minimal postoperative hypersensitivity and a good prognosis for abutments. The long term fluoride release and upta=e of glass ionomer restoratives has been reported and the cariostatic activity of glass ionomer cements has been proposed. >o/ever: although fluoride is released: the small R!uantity of cement at the margin may not have any significant clinical therapeutic value as a cariostatic agent. 2lass ionomer cements are indicated for cementing cast restorations in the same manner as ?inc phosphate cement. #ESIN COMPOSITE CEMENT Resin cements are variations of filled F&$120A resin and other methacrylates. They polymeri?e through chemically initiated mechanisms: photopolymeri?ation: or a combination of both. They are available in various shades and opacities and their chemistry allo/s them to adhere to many dental substrates. Adhesion to enamel occurs through the micromechanical interloc=ing of resin to the hydro5yapatit.e crystals and rods of etched enamel. Adhesion bf resin to dentin is more comple5: involving penetration of hydrophilic monomers through a collagen layer overlying partially deminerali?ed apatite of etched dentin. %entin RadhesionR is obtained by inf1ltration of resin into etched dentin: producing a micromechanical interloc= /ill partially deminerali?ed dentin: /hich underlies the hybrid layer or resin interdiffusion ?one. Adhesion to dentin /ith resins re!uires multiple steps: beginning /ith the application of an acid or dentin conditioner to remove the smear

,*

layer: smear plugs: open and /iden tubules and deminerali?e the top

to )1mm of

dentin. The acid dissolve and e5tracts the apatite mineral phase that normally covers the collagen fibers of the dentin matri5 and opens B to #B nrn channels around the collagen fibers. These channels provide an opportunity to achieve mechanical retention of subse!uently placed hydrophilic adhesive monomers. An optimal to ) micro miter ?one of deminerali?ation has been described /ith a 1) seconds application of conditioner. Prolonged application of acids to dentin results in a deeper deminerali?ed ?one that resists subse!uent resin infiltration. &f complete infiltration of the collagen by the primer does not occur: the collagen at the deeper deminerali?ed ?one /ill be left unprotected and sub3ected to future hydrolysis and final brea=do/n. After deminerali?ation: the primer: a /etting agent such as >E0A is applied. The agent is bifunctional: in that it is both hydrophilic: /hich enables a bond to dentin and hydrophobic: /hich enables a bond to the adhesive. The primer is applied in multiple coats to a moist dental surface. 0ultiple coats are re!uired to replace the /ater in the damp dentin /ith the resin monomers and to carry the adhesive material into the tubules. The primer is gently dried so as not to disturb the collagen net/or= but to remove any remaining organic solvents or /ater that could obstruct the :contact of the resin adhesive /ith the primer. Adhesive resin is then applied to the RprimedR surface to stabili?e the primer1infiltrated deminerali?ed dentin and to penetrate into the dentinal tubules. $ubtle differences in the amount of cross1lin=age and penetration bet/een commercial adhesives can occur. The use of dentin bonding agents has some/hat compensated for the polymeri?ation shrin=age evident /ith all resin composites. >o/ever: the rigidity of cast restoration of the resin adhesive and the stresses generated /ithin the shrin=age cement vary /ith cement type: thic=ness: and cavity geometry. These stresses may be substantial enough to form gaps bet/een the cement and the tooth. Adhesion to tooth structure benefits from a thin resin layer: if the bond can overcome polymeri?ation stresses. $tudies have reported that the bond 1strength of resin composite luting agent to etched ceramic may e5ceed the bond to dentin /hen ne/ generation dentin bonding agents are used. Although polymeri?ation shrin=age continues to be an impediment to complete dentinal adhesion for this type of cement: the adhesion obtained

,+

is sufficient to /arrant the use of these agents for cementing cro/ns short: tapered preparations /ith non1ideal angles convergence. Resin composite resin bond chemically to resin composite restorative materials and to silanated porcelain. Resin adhesives increase the fracture resistance of ceramic materials that can be etched and silanated. Resin cements also demonstrate good bond strengths to sandblasted base metal alloys as a result of micromechanical retention: and the '10ETA resin cements sho/ strong adhesion as a result of chemical interaction of the resin /ith an o5ide layer on the metal surface. Noble alloys may be electroplated /ith tin to increase the surface area for bonding and perhaps enable a chemical bond to the deposited tin o5ide. 0ost resin adhesives are filled )BH to +BH by /eight: /ith glass ionomer or silicaM they e5hibit high compressive strength: resistance to tensile fatigue: and are virtually insoluble in the oral environment. The filler also contributes to improved marginal /ear resistance in comparison to hybrid resin and glass ionomer cementsM ho/ever: a high filler content increases viscosity: /hich in turn reduces their flo/ and increases film thic=ness. The ability to seat restoration /ith the resin cements has been investigated and: in some situations: cement film thic=ness has been found to be greater than other classes of cements. Cement film thic=ness can be reduced /ith the use of electromallet or ultrasonic devices. >o/ever: as /ith polycarbo5ylate cements: the bond strength of resin composite adhesives to metal has been found to increase: up to a point: /ith a concomitant increase in cement film thic=ness. $ome resin composite cements contain ytterbium trifluoride and are capable of some fluoride release. Cther formulation includes a barium fluorosilicate filler and claim additional fluoride release. This may imply that the cements offer cariostatic potential. >o/ever: significant sustained fluoride release of resin composite materials or real clinical therapeutic value has yet to be described. The amount of fluoride release needed to inhibit enamel deminerali?ation has not been defined and controlled clinical trials have not been proven the cariostatic efficacy of fluoride < releasing materials.

,,

The ability to adhere to multiple substrates: high length: insolubility in the oral environment: and shade1matching potential has made resin composite cements the adhesive of choice for esthetic type restorations. Adhesion to noble metals can be achieved but re!uires tin1plating. Resin cements are. useful /hen the preparation lac=s optimal retention and resistance forms. Proper use re!uires multiple steps that are techni!ue sensitive. &nspite of its various advantages: resin adhesives are even more techni!ue sensitive during its usage inside the root canal. The uniform etching of the root canal space and the removal of the etch ant have to be done meticulously. 0oreover: the effect of the etchant on the underlying apical gutta percha has not been studied properly. A predictable bond strength is !uestionable until a uniform layer of the adhesive is applied throughout the root canal space. Cne of the most common failures in this system is inade!uate polymeri?ation of the resin. $everal studies have been conducted to evaluate the retention of do/els luted /ith resin cement in teeth that /ere obturated /ith gutta percha using a eugenol sealer or a calcium hydro5ide sealer. Eugenol @ 1metho5y1'1 allyphenolA: an obtundent to pulpal tissues: is found in many dental products including dental sealers. 0any clinicians prefer sealers containing eugenol: possibly because of its antimicrobial activity that could improve the clinical success of the endodontic therapy. >o/ever: numerous studies have sho/n the inhibiting effect of eugenol on the free radical addition polymeri?ation reaction of chemically cured composite resin. &nhibition occurs: because eugenol reacts /ith free radicals associated /ith resin polymeri?ation. The use of a eugenol containing sealer may also affect resin cement polymeri?ation /hen a do/el and core is luted. &t has been sho/n that eugenol can reduce the bond strength of resin to dentin and negatively influence the retention of a do/el in a prepared do/el space. &n a study by T3an et al on the effect of eugenol containing endodontic sealer on the retention of prefabricated do/els luted /ith an adhesive composite resin cement: they found eugenol significantly reduced the retention of Para Post do/els luted /ith Panavia ES composite resin cement. They also reported that canal irrigation /ith ethyl alcohol or etching /ith phosphoric acid could assist in negating eugenolPs influence: resulting in increased bond strengths. >o/ever in this study: the eugenol containing endodontic

,.

sealer li!uid /as introduced directly into the canal immediately before placing the do/el and resin1luting agent. This protocol may not provide an ade!uate understanding of the influence of eugenol in a clinical setting /hen set sealer and gutta percha are removed from a canal during post space preparation. &t has also been sho/n that by mechanically cleaning a dentin surface /ith pumice before dentin bonding: the eugenol1based cements have no effect on the dentin1resin bond strength. Recent studies /ith ne/er dentin bonding systems have sho/n no adverse effect on the dentin bond after eugenol contamination. Furns et al have conclusively proved that conventional endodontic obturation using a eugenol containing or calcium hydro5ide containing endodontic sealer did not affect the retention of prefabricated stainless steel do/els luted /ith resin cement. #ESIN MODI&IED. 3L*SS IONOME# CEMENTS This fifth class of luting agents hardens by setting reactions that lead to the formation of a metal poly acrylate salt and a polymer. These cements harden to an acid1 base reaction bet/een fluoroaluminosilicate glass po/der and an a!ueous solution of polyal=enoic acids modified /ith pendant methacrylate groups: and by photo1initiated or chemically initiated free radial polymeri?ation of methacrylate units. Fecause of this chemistry: the cements are termed resin1modified or hybrid glass ionomer. These cements have compressive and diametral tensile strengths greater than ?inc phosphate: polycarbo5ylate: and some glass ionomers but less than resin composite. Their adhesion to enamel and dentin: and their fluoride release pattern is similar to glass ionomer cements. &n addition: they also bond to resin composite. They are more resistant to /ater during setting and are less soluble than glass ionomers. These cements may have some cariostatic potential and resistance to marginal lea=age. Perhaps the biggest advantage of these types of cements is their case .of mi5ing and use: because multiple bonding steps are not re!uired. They also have ade!uately lo/ film thic=ness. &n addition of resin has not significantly reduced dehydration of the glass ionomer component of these cements: and dehydration shrin=age has been observed as late as # months after maturity. A significant disadvantage of the resin ionomers is the hydrophilic nature of polymeri?ation >E0A: /hich results in increased /ater sorption and subse!uent plasticity and hygroscopic e5pansion. This behavior is analogous to a

.B

synthetic hydrogel. Although initial /ater sorption may compensate for polymeri?ation shrin=age stress:P continual /ater sorption has deleterious effects: Potential for substantial dimensional change contraindicates their use /ith all ceramic feldspathic 1 type restorations. 0anufacturers of resin ionomer cements recommend that they be used for luting metal or porcelain fused 1 to1 metal cro/ns and FP%s to tooth: amalgam: resin composite: or glass ionomer core buildups: but their use for cementing posts in non viral teeth is !uestionable because of the potential for e5pansion induced root fracture. Resin ionomer cements present concern regarding biocompatibility due to the presence of free monomer in the li!uid: Although rare: dimethacrylate may elicit an allergic response Pfrom certain persons and careful handling by dental personnel is recommended during mi5ing. The application of desensiti?ing agents after tooth preparation can seal dentinal tubules and decrease microlea=age. $tudies have reported that resin primers may decrease the retention of ?inc phosphate and polycarbo5ylate cements: but have little effect on glass ionomer: resin composite: resin modified glass ionomer cements. &t is =no/n that eugenol1containing materials inhibit the cross1lin=ing of resin adhesives. 7hile noneugenol containing cements are recommended for luting interim restorations before final cementation /ith resin adhesive cements: retention of resin modified glass ionomer cements is not significantly affected by eugenol 1 containing provisional materials: as long as the provisional cement is completely removed /ith a thorough prophyla5is.

.1

CEMENT*TION TECHNIE-E &t has important effect on the eventual retention and stress distribution of the post. Essential to achieve a uniform: bubble free layer of cement that distributes the stress evenly throughout the entire root canal. 8se of a lentulosprial < considered to be superior to place the cement into the canal. &t gives better spinning and spreading of the cement because of centrifugal dispersion of the cement. &t also reduces voids and increases the contact of the cement /ith the /alls. %uring cementation < post space should be free of any residue: as it has been reported that even a small nodule on the post surface or temporary cement residue in the canal can generate enough force to cause root fracture during and after post cementation. Cther possible causes of root fracture are E %evelopment of hydrostatic pressure in the cement E5cessive seating pressure E5cessive tor!ue e5erted by the clinician on the post during cementation.

Fefore cementation of the post E 1. Post space should be cleaned by a chelating agent: 1+H E%TA for #B seconds. . Follo/ed by rinsing /ith ). H NaCC& @#B secA #. Canals should be rinsed /ith /ater and dried /ith paper points. This procedure /ill help the post space /all to be free of root canal sealant: debris and dentinal smear layer.

Treatment of the $ost 'efore cementation

To enhance retention: the surface of the post can be micro1roughened before cementation /ith )B1micron aluminum o5ide and a micro air abrasive unit @0icroEtcher: %anville Engineering &nc.: %anville: CAA /ith *B p.s.i. air pressure. Fefore cementation

4inc Film thic=ness 7or=ing time $etting time Comp. $trength @0PAA Elastic modulus Pulp irritation $olubility 0icrolea= age Removed of Retention phosphate ) 1.)1) )11' * 11B1 1#. 0oderate >igh >igh Easy 0oderate

Poly carbo5ylate T ) 1.+)1 .) *1. *+1.1 1 (o/ >igh -ery high 0edium (o/1 moderate

2&C T ) .#1) *1. 1 11. >igh (o/ (o/1high 0edium 0oderate1 high 11*

Resin ionomer N ) .'

Compomer N ) #.1B #1+

Adhesive resin cement B.)1) 111) 1+.1 )) '.)1.., >igh -ery lo/ -ery lo/ to lo/ %ifficult >igh

'B11'1 1 >igh -ery lo/ -ery lo/ 0edium 0oderate1 high

1.'1 BB 1+ >igh -ery lo/ >igh1to very high 0edium 0oderate

.#

0entin" )
Fecause of the intraradicular hydrostatic pressure created during cementation of the post: a means for cement to escape must al/ays be provided. Fecause virtually all prefabricated posts have a venting mechanism incorporated in their design: this factor is important /ith the custom cast post. A vent may be incorporated in the pattern before casting or into the /ith a bur prior to cementation.

.'

P#O0ISION*L #ESTO#*TIONS &O# ENDODONTIC*LL. T#E*TED TEETH A temporary restoration commonly plays an important role in the successful restoration of a tooth. &t is true that the normally essential role of pulpal protection is not of concern in dealing /ith an endodontically treated tooth. Nevertheless: the temporary restoration may be even more important to the patent receiving a do/el1core and a cro/n. FunctionsE1 Esthetic role Protects the tooth from further damage Prevents migration of ad3acent contacting teeth Provides occlusal function

A number of different cro/n formers and do/els are used in various combinations. Polycarbonate cro/ns have been relined /ith acrylic: as have celluloid cro/n forms. Cver impressions and plastic shells have used to form the outer contours of the cro/n. Cther types of retentive devices have included plastic do/els relined /ith acrylic resin: a silicone do/el reinforced /ith a paper clip: metal do/els /ith no acrylic lining: and a /ooden match stic=. $ome prefabricated do/el systems have steel do/els made specially for temporary cro/ns. >o/ever: they /or= best if the matching reamer /as used in preparing the canal for the final do/el1core. The polycarbonate cro/n is /ell suited for the routine single cro/n. &f the temporary restoration involves a bridge: or unusual alignment or morphology in a single cro/n: a custom plastic shell /ill probably provide the best result in the shortest time. Po!ycar'onate Crown The polycarbonate cro/n is used /ith a paper clip do/el to provide temporary coverage for the endodontically treated tooth. The coronal portion of the restoration is composed of a polycarbonate cro/n: relined /ith acrylic resin.

.)

&nitially: a cro/n is chosen that has dimensions compatible /ith the space it /ill occupy. &n most cases: the cro/n /ill not adapt around the e5isting root /ithout modification. E5cess length is removed form the gingival margin of the cro/n: /hile the incisal area is left intact. This process is continued until the cro/n is adapted reasonably /ell to the gingival finish line: /ith the incisal edge in the proper position relative to the ad3acent teeth. A section of paper clip made of heavy gauge /ire is placed into the canal to its full depth. A felt tip pen mar= is placed 1' mm. above the remaining coronal tooth structure. The length of /ire e5tending into the cro/n /ill be dictated by the length of the cro/n. The longer the e5posed piece of paper clip: the better its retention in the acrylic resin in the cro/n. 8sing a separating disc: cut the length of paper clip.. $ome small notches can be placed in the /ire at this time to assist in retention of the resin. Place a bend near the end of the /ire. 7hen embedded in the temporary cro/n: this bend /ill prevent the do/el from pulling out and rotating. Try the trimmed do/el in the canal and confirm that the polycarbonate cro/n /ill have room to seat /ithout binding on the /ire. The root face is lightly lubricated /ith petrolatum to prevent any acrylic resin from stic=ing to the tooth during polymeri?ation. A thin mi5 of temporary acrylic resin is placed on the root face around the orifice of the canal. Avoid placing any resin deep into the canal space itself: since this can ma=e the cro/n difficult to remove. &nsert the paper clip do/el into the canal. Fill the polycarbonate cro/n /ith the same mi5 of acrylic resin. Eliminate any voids in the material before placing it on the tooth. $eat the cro/n and confirm that it is in the proper position relative to the ad3acent teeth. E5cess acrylic can be removed /ith an e5plorer to ma=e trimming easier. As the material reaches a doughy consistency: the cro/n should be pumped in and out of the tooth several times to avoid being loc=ed in place during polymeri?ation.

.*

The pin1temporary cro/n can be placed in hot /ater to speed polymeri?ation. Prior to trimming and contouring: it is helpful to mar= the margin on the inside of the cro/n /ith a sharp pencil. The temporary cro/n is trimmed /ith sandpaper discs. The polycarbonate cro/n /ill fre!uently be overcontoured in the gingival one1third. $pecial attention should be given to properly shaping the restoration and ma=ing any needed ad3ustments in occlusion. Perforating the polycarbonate cro/n is not a problem because there is an underlying bul= of acrylic. The temporary cro/n is first polished /ith fine pumice and then /ith a high1lustre denture polish. Temporary cement should be placed only in the coronal portion of the restoration. Avoid getting cement in the canal space. A ?inc o5ide1eugenol cement mi5ed /ith an e!ual part of petrolatum is acceptable. $eat the pin1temporary cro/n and hold it in place /ith firm finger pressure until the cement is set. Carefully clean the e5cess cement from around the margins.

C!ear P!astic She!! Another method for constructing a pin1temporary cro/n involves the use of a clear plastic shell. 7hile the shell can be shaped by a vacuum forming machine: it is more easily and economically adapted by using silicone putty. Fegin by placing the putty into an unperforated stoc= metal impression tray. Cut a sheet of coping material in half and place it in a /ire frame: shiny side do/n. The plastic material is slo/ly heated over a flame until it sags. &f it is translucent: it should become clear as it softens. &f the material is the clear variety: it should be heated until it begins to smo=e slightly. The heated coping material is !uic=ly carried to the diagnostic cast. &f the tooth to be restored is badly bro=en do/n: it should have been /a5ed to an acceptable contour and duplicated in plaster or stone. A duplicate cast is necessary because the hot plastic /ould melt the /a5 if it /ere placed on the original cast. The tray loaded /ith putty is placed over the plastic and firmly seated on the cast. Compressed air can be blo/n on the shell to speed cooling. After about #B seconds: the

.+

tray and the silicone putty are removed. A /ell adapted plastic shell covers the cast. The coping material is removed from the cast and trimmed /ith scissors. The finished shell should e5tend at least one tooth in either direction from the tooth being restored. &t should also be trimmed to e5tend no more than 1# mm: beyond the gingival sulcus. A paper clip is prepared in the same manner described previously. The end is bent to aid retention in the temporary cro/n. The shell is filled /ith temporary acrylic resin. Fefore seating the shell: e5amine the acrylic from the outside to ma=e sure there are no obvious voids or bubbles. They can be eliminated much more easily at this time than they can be filled in later. &f the mold appears ade!uately filled: the shell can be seated. 0a=e sure that it is in the proper position by firmly pressing on the incisal edges of the ad3acent teeth. Avoid pushing on the tooth being restored because the coping material may over seat and distort the temporary cro/n. 7hen the material reaches a doughy consistency: remove the shell and separate it from the temporary cro/n. &f it is left in place too long: it can be loc=ed in place in the canal or bet/een ad3acent teeth. Trim off as much flash as possible /ith scissors /hile the acrylic is still doughy. Reseat the cro/n on the tooth and remove it. %rop the temporary cro/n in a bo/l of hot /ater to speed polymeri?ation. The temporary cro/n is contoured /ith a sandpaper disc. Chec= the occlusion and ad3ust as necessary. Polish the cro/n first /ith pumice and then /ith high luster denture polish. Cementation procedure is same as that described for polycarbonate.

.,

#ECENT *D0*NCES ,. Non Meta!!ic $osts) 1. Car'on fi're $ost) The carbon fiber posts /ere introduced in 1..B follo/ing research underta=en by %uret and associates in France. They consist of continuous: unidirectional: pyrolytic carbon " graphite fibres reinforced in an epo5y resin matri5 /ith *'H carbon. Parallel sided: smooth post: /ider coronally and tapers to/ards the ape5. Ty$es of Car'on &i're Posts 1. Composi post E @RT%: FranceA . EndopostM @RT%: FranceA #.Carbonite systemM @$/it?erland: =entA '. 0irafit carbonM @>ager 7er=en: 2ermanyA ADVANTAGES: 1. Fetter strength . >igh fle5ibility #. Easy retrievability '. Fetter redistribution of stresses ). >igh fatigue resistance DIS*D0*NT*3ES) 1. Aesthetics< the blac= colour of post has a negative effect on the final aesthetic result of all ceramic cro/n . Poor adhesion to composite resins as the heat processed carbon fibre posts have little free resin available for chemical reaction causing failure of post " cement interfere. #. (ac= of radioopacity1 Ne/ advances /ith second generation tooth coloured posts:

/ere introduced to improve this aesthetic challenge. These are termed as $ilica fibres posts " 2lass fibre posts " Guart? fibre post.

..

COMPOSIPOST S.STEM PThe Composipost system @RT%: 0eylan: FranceA: comprising a carbon fiber post: a composite core material: and a lo/ viscosity Fis120A bonding resin: has been recently introduced to the mar=et /ith the manufacturers claiming several interesting advantages over e5isting productsE 1. Complete post" core and cement system in one =it. . >omogenous mechanical and chemical bonding of all components: /hich serves to reinforce the tooth #. Carbon fiber post has a UoungPs modulus appro5imating that of natural teeth: /hich results in decreased stress concentration and therefore an increased longevity of the restoration. $idoli et al assessed the compressive strength values of endodontically teeth restored /ith the Composipost post and core system /ith teeth restored /ith Parapost stainless steel posts and composite coreM and cast gold post and core. The results indicatedE a. 7hen tested /ith a single angle compressive load: teeth restored /ith the Composipost post and core system e5hibited significantly inferior stress values at failure /hen compared /ith the other systems. b. The mode of failure of the Composipost and core system: /ith angled compressive load testing: ho/ever: /as more favorable to the remaining tooth structure. Cne potential advantage of a fractured Composipost system: compared /ith a metallic post: is the relative ease of removal from the posthole by conventional rotary instruments.P This factor: combined /ith the less destructive nature of tooth damage: /ould allo/ the possibility of salvage and repreparation /ith the minimum of comple5 treatment. A further advantage is the elimination of corrosion /hen a carbon post is used in combination /ith a composite core: compared /ith some metallic post and core systems that e5hibit corrosion. The Composipost do/el is made of e!ually stretched and aligned carbon fibers: solidly attached to a special matri5 of epo5y resin. The interface bet/een the carbon filaments and the matri5 is an organic composition. The carbon fibers by e5erting

1BB

uniform tension on the filaments impart high strength to the posts. The composipost do/el has a cylindrical shape: and it tapers into t/o conical shaped seating faces of different diameters for stability. The height of the conical seating is 1 mm. All the posts have the same overall length of mm and are available in the follo/ing diametersM .

8pper $han= %iameter E 1.' mm: 1.,mm and .1 mm. lo/er $han= %iameter E 1.B mm: 1. mm and 1.' mm. Composipost are passive and are designed to be used /ith a bonding techni!ue. The recommended core material is Resilient composite: a F&$20A resin filled /ith short glass fibers. Foston . Post or stic=y post resin cements /ere used previously for bonding. They are no/ placed by a ne/ bonding system: /hich is a radio opa!ue composite dual cure cement associated /ith a primer such as Allbond . &t provides high bond strength and a hybrid layer: furthermore clinical procedures for Composipost are 1cH time consuming and e5pensive than the conventional procedures for cast metal posts.

1B1

TOOTH COLO-#ED POSTS 0a3or disadvantage of metal posts and CFPIs is their dar= colour: /hich adversely affects the natural appearance of the restored tooth. To overcome this disadvantage tooth coloured posts /ere developed. Si!ica fi're $osts) 1. "!ass fi'er $osts 2. (uart+ fi'er $osts 3!ass &i'er Posts 2lass fibers have a lo/er elastic modulus than carbon " graphite fibers. These posts can be made of different types of glasses. i. E!ectrica! "!ass <E6"!ass5 6 is the most commonly used glass type in /hich the amorphous phase is a mi5ture of $ilicon di C5ide: Calcium C5ide: Farium C5ide: A1uminium C5ide and some other o5ides of al=ali metals. ii. Hi"h stren"th "!ass<S6"!ass5 6 is also amorphous but differs in composition.

T.PES O& 3L*SS &I,#E POSTS: 1.$no/ Post < @Carbotech: FranceA . Parapost fibre /hiteE <Cottene " 7haledentA #. 2lassi5 E @>arald Nordin $a: $/it?erlandA '.. 0irafit /hiteE @>ager 7er=en: 2ermanyA ). (uscent anchorE @%entatus: $/edenA *. Fibre =or E @ Leneric " Pentron: 8$AA +.FRC postec E @ &voclar " -ivadent A

1B

FRC Postec

2lassi5 post system

1B#

E-*#TD &I,#E POSTS) Additionally glass fiber post can also be made of !uart? fibers. Guart? is pure silica in crystalli?ed form. &t is an inert material /ith a lo/ co1efficient of thermal e5pansion @CTEA. T.PES O& E-*#TD &I,#E POSTS) &. Aestheti postE @RT%: FranceA &i. Aestheti plus postE @RT%: FranceA &ii. (ight postE @RT%: FranceA iv. $tyle postE @0etalor technologies: (ondonA Ad an!a"es 1. Fle5 /ith the tooth structure . Easy to retrieve: if retreatment is re!uired #. Aesthetic compatibility '. 2reater fracture resistance ). 8seful in polymeri?ation by transmitting tight through the post. Physical properties of these posts is similar to carbon fibre posts.

1B'

*LL 6 CE#*MIC POSTS *ND CO#ES &n 1.,.: 6/iat=o/s=i and 2ellerl described the clinical application of glass1 ceramic posts and cores @%icor: %entsplyA and in 1..1: 6ern introduced posts and cores made of glass1inf1ltrated aluminum o5ide ceramic &n 1..): Pissis1'': proposed a monobloc techni!ue for the fabrication of a post and core and a cro/n as a single component made out of glass ceramic material &n 1..' and 1..): $andhaus and Pasche and others introduced prefabricated ?irconia ceramic endodontic posts to restorative dentistry The ma3or advantage of an all ceramic post and core is its dentin li=e shade. The positive contribution of the dentin shade ceramic core is related to the deeper diffusion and absorption of the transmitted light in the ceramic core mass. An all1ceramic restoration transmits a certain percentage of the incident light to the ceramic core and post on /hich it has been placed. Thus /ith all ceramic posts and cores: the color of the final restoration /ill be derived from an internal shade similar to the optical behavior of the natural teeth. &n addition: a ceramic post does not reflect intensively through thin gingival tissues: and it provides an essential depth of translucency in the cervical root areas. All ceramic posts and cores: as metal free constructions: provide an e5cellent biocompatibility and do not e5hibit galvanic corrosion. Relatively lo/ fracture strength and fracture toughness are the main obstacles for an e5tended use of conventional dental ceramics as post and core materials. There are fe/ research data on the fracture strength of all ceramic posts and cores: and for clinical behavior no long term clinical data are provided in the literature. Apart from the fracture strength: the fracture toughness of a ceramic material seems to be more predictive of its failure rate. >igh toughness ceramics: such as the glass int1ltrated alumina ceramic &n1Ceram and the dense sintered alumina ceramic Procera @Nobel Fio careA: sho/ a # to * times higher fle5ural strength and fracture toughness than do conventional feldspathic and glass ceramics. Contemporary ?irconia po/der technology contributes to the fabrication of ne/ biocompatible ceramic materials /ith improved mechanical properties: ie.: further

1B)

increased fle5ural strength and fracture toughness. Therefore: ?irconium o5ide ceramic seems to be a very promising material for the fabrication of all ceramic posts and cores. SLIP 6 C*STIN3 TECHNIE-E The fabrication of all ceramic posts and cores by use of the slip casting techni!ue /as described by 6ern and 6node in 1..1. 7ith this techni!ue: the core buildup and the post are made in 1 piece from the aluminum o5ide ceramic material: &n Ceram. Fecause of the limited fracture strength and the un=no/n long1term clinical prognosisE of &n1 Ceram as a post and core material: this method should be used only in /ide root canals /ithout a crucial reduction of the circumferential dentin structure. The preparation of the root canal is similar to the preparation for a metal post and core. Possible undercuts are eliminated manually /ith standardi?ed reamers during the root canal preparation. At the coronal end of the root canal: a small inlay cavity is prepared to prevent rotation of the finished post and core. The tooth preparation for an all ceramic cro/n re!uires a .BQ shoulder /ith a rounded internal angle or a deep chamfer /ith a /idth of 1.B to 1. mm circumferentially. As the preparation is finished: all line angles should be slightly tapered. A prefabricated plastic or metal post is placed in the root canal and a high precision impression is ta=en. After the master cast is set: the tooth die is sectioned and the preparation margins are e5posed and mar=ed /ith in=. The die is duplicated: and a second die is cast /ith the special &n1Ceram plaster. The duplicated die is used for formation of the post during the slip casting. After its hardening and removal from the

$lip casting before sintering

$intered post and core

2lass infiltered post D core

1B*

impression: the bottom of the second die is ground /ith a carbide bur until a tiny opening appears. %uring the slip casting: this hole serves as an e5ternal relief that prevents air impaction in the slip mass. &n addition: it is a reliable indicator of the slip in3ectionPs completion. Finally: hori?ontal and vertical sections: /hich must not reach the root canal are made on the die /ith diamond dis=s. As an alternative method: the /or=ing die can be separated into pieces by the insertion and a slight rotation of a sharp =nife in a drain channel cut along the die. These parts are glued together: again /ith cyanoacrylate adhesive. The adhesive is burned out /hen the furnace is heated to 1BB degree centigrade: so that no force is e5erted by the shrin=ing die at higher temperatures. 7a5 up of the core is then made on the master die: andM the occlusal clearance is confirmed on an articulator. %iameter /a5 sprue is attached to the 1incisal edge of the core: providing later the entrance for the slip in3ection. T/o putty silicon molds of the /a5 up and the master cast are fitted together /ith internal retentive undercuts. After the removal of the /a5 up: the die of the special &n Ceram plaster is adapted bet/een: and finally the silicon molds are 3oined /ith rubber rings. 7ith this procedure: a void space: previously occupied by the core /a5 up and the sprue: is provided for the slip in3ection. The alumina slip is mi5ed and ultrasonically vibrated to a homogenous consistency according to the manufacturerPs instructions and then is in3ected through the in3ection spine of the silicon mold. After the slip has dried: the core is carefully carved to its final shape /ith a scalpel. Cne coat of $tabili?er @-ita 4ahnfabri=A is applied to the finished core. The sintering is done according to the regular firing cycle settings for the &n Ceram ceramic: as recommended by the manufacturer. After sintering: the all ceramic post and core is fitted to the master cast. Then it is chec=ed for possible micro1crac=s by the use of methylene blue li!uid. For the subse!uent glass infiltration firing: the post and core is placed on a platinum foil and is covered /ith a mi5ture of lanthanum 1 glass po/der and the special li!uid supplied /ith the &n Ceram system. The e5cess glass is removed /ith coarse grit diamond grinding and )B urn air abrasion. Then the all ceramic post and core is fitted again to the master cast.

1B+

After the fit of the all ceramic post and core is chec=ed in the patientPs tooth: the post and core is adhesively cemented. Rubber dam is applied for moisture control. The root canal is roughened /ith a diamond coated reamer and cleaned /ith +BH alcohol. A self1curing dentin adhesive agent is used prior to cementation /ith a self curing resin cement. &f a phosphate monomer containing resin composite is used for the cementation: the In Ceram post and core need only be sandblasted and ultrasonically cleaned in .*H alcohol. After the resin cement has set: the e5cess cement is removed by diamond grinding: and the tooth preparation is finali?ed /ith finishing diamonds. COP. 6 MILLIN3 TECHNIE-E Recently: the glass infiltrated alumina ceramic: &n Ceram: and its fabrication process have been adapted to the Celay copy milling method @0i=ronaA: as an alternative to the slip casting techni!ue. The Celay system involves a manually guided copy milling process in /hich aE pre1designed resin pattern is surface traced and copied in ceramic. The ceramic substructures are prefabricated blan=s made of presintered aluminum o5ide ceramic @Celay Alumina Flan=s: -ita 4ahnfabri=A. &n Ceram ceramic restorations made /ith the Celay method present a 1BH higher fle5ural strength @about )BB 0paA then do conventional &n Ceram restorations. This method can be used for inlay: onlay: veneer: and cro/n and bridge frame/or= fabrication: as /ell as for copy milled &n Ceram posts and cores. The clinical indications and procedures are similar to those of the conventionally slip cast posts and cores already described. For the copy milling techni!ue: the resin Ppre1post and coreP pattern can be made by a direct or an indirect method. The direct method presupposes that the resin analog of the post and core is modeled on the patientPs tooth: similar to the conventional techni!ue for casting metal posts and cores. This intra oral method is simplified by the use of prefabricated plastic or metal posts in combination /ith the appropriate root canal system

1B,

For the indirect method: an impression of the prepared tooth is ta=en and a /or=ing cast is poured out of plaster. The resin pre post and core is modeled as in the indirect fabrication method for metal posts1 and cores. For the molding of the internal inlay of the post and core: a light curing resin /ith increased viscosity @eg.: -isioform: E$PEA can be used to simplify the handling. After the resin pre post is completed: it is mounted to the tracing chamber of the Celay machine. The pre post is mounted vertically: so that the incisal edge of the core is attached to a 3ig of the retentive device and the end of the post is connected to a pin on top of the cup holder. Then: the resin pattern is surface traced and copied in ceramic by synchroni?ed grinding in the milling chamber. For a precise fit: special attention should be paid /hen the internal inlay is milled. After completion of the copy milling process: the ceramic post and core is cut off /ith a diamond dis=M fitted to the master die: glass infiltrated: and finished as described above. T>O PIECE TECHNIE-E Fecause the fracture strength of &n Ceram posts and cores is less than that of metal posts and cores: &n Ceram posts and cores have only been recommended for /ide root canals. &n cases of regular root canals @smaller than &$C 11BA: &n Ceram ceramic does not seem to provide a sufficient strengthM for that reason: until presently: an all ceramic post and core /as not recommended for such cases. After the recent development of ?irconia ceramic posts: it became possible to combine both materials. For a piece post and core construction: a post made of yttrium o5ide partially stabili?ed ?irconia @ER Cerapost: FrasselerA is used in con3unction /ith an all ceramic core made of alumina or alumina magnesia ceramics: fabricated either by the copy milling or the slip casting techni!ue. The ?irconia ceramic posts are commercially available in three &$C si?es @B)B: B.B: 11BA and supplement the e5isting ER Post system @FrasselerA. This techni!ue is also applicable for both direct and indirect fabrication methods. For the direct method: the root canal is prepared: and the selected ?irconia ceramic post is tried in A core is formed intra orally by adapting the light curing resin composite Celay Tech to the inserted post. After the removal of the resin core from the post: the core is copied in ceramic in the Celay machine. For the indirect fabrication method: an

1B.

impression of the inserted post is ta=en: and a /or=ing die is cast. The core is then formed /ith the light curing resin composite Celay Tech on the master cast. Finally: it is also copied into ceramic. As an alternative to the copy milling core fabrication: the slip casting techni!ue can be used as described earlier: /ith a minor modification. A plastic post of the ER $ystem is inserted in the root canal of the special In Ceram plaster die. This plastic post provides accurate space for the ?irconia ceramic post and does not cause any problems because it is burned out during the sintering firing. After the core /a5 up and the t/o silicon molds are made: the slip is in3ected as described for the slip casting techni!ue. A fter glass infiltration firing: the infiltrated alumina core and the ?irconia post are sand blasted and ultrasonically cleaned in .*H alcohol. For cementation: an adhesive resin @eg.: Panavia 1: 6urarayA is applied to the bonding surfaces of the post and core: and then they are both luted to the abutment tooth. Primarily: the ceramic core is placed on the prepared tooth and immediately after/ard the post is inserted in the root canal through the canal of the core. Finally: after setting of the luting resin: the post is shortened at its protruding occlusal end: and the tooth preparation is finished. 7hen a sufficient amount of a caries 1 free tooth substance is available: instead of the ceramic core buildup: a self curing resin composite buildup can also be used in combination /ith a ?irconia post.

11B

HE*T 6 P#ESS TECHNIE-E The heat press techni!ue has recently found application to an all ceramic post and core construction. &t is based on the /ell =no/n &P$ Empress system @&voclarA. &n this system: a castable: pre1cerammed leucite reinforced glass ceramic material is heated and pressed in an investment mold after the burn out of the /a5 analog @lost /a5 techni!ueA. &n the heat press techni!ue: a glass ceramic core @Empress Cosmo: lvoclarA is heat pressed over a prefabricated ?irconium dio5ide post @Cosmo Post: &voclarA: and therefore both materials are fused into a solid post and core restoration. For the root canal preparation: special reamers @Cosmo Post $et. &voclarA is used so that the canal can receive a ?irconia post /ith the appropriate diameter @1.' or 1.+ mmA. After the impression is ta=en and the master cast is constructed: the core /a5 pattern can be molded in the laboratory. An intra oral direct method can also be employed /ith the use of a self curing resin @2C Pattern: 2CA after insertion of the post in the root canal. The heat press procedure: /hich is identical for both methods: is follo/ed. A #.B mm diameter and *.B to ,.B mm long /a5 sprue is attached to the core /ith an inclination that allo/s a uniform flo/ and e5pansion of the glass ceramic. At that time: the post and core is invested in a phosphate bonded refractory die material. The heat press procedure is performed in a specially designed furnace @&P$ Empress EP )BB: &voclarA. The ceramic ingot is first heated at 1:1,B degree centigrade and then is pressed /ith B.# to B.' 0pa pressure under vacuum. After cooling and divestment: the post and core: as a solid: all ceramic construction: is fitted to the master cast. Then: it is tried in the patientPs mouth and adhesively cemented as previously described.

111

DI#ECT METHOD &O# CE#*MIC POSTS

After tooth preparation: if sufficient tooth structure remains: a ceramic post can be placed. A prefabricated all ceramic post @FiopostA or TSP post: /hich is biocompatible and has favorable mechanical properties: and can be used /ith a composite core. The tooth selected for this procedure should have at least half the height of the future cro/n preserved in dentin. Prepare the root canal for the post: based on contemporary biomechanical principles using a series of specific cylindrical burs in accordance /ith the manufacturerIs directions. $elect a post of suitable length and diameter /ith the aid of a radiograph. $andblast the corresponding ceramic post and cement. Complete the core reconstruction /ith resin and prepare the tooth for an all1 ceramic cro/n.

11

>O0EN6&I,#E COMPOSITE M*TE#I*LS% M*TE#I*LS)

POL.ETH.LENE &I,#E

The use of cold gas plasma treated: polyethylene /oven fibres embedded in conventional resin composite has been advocated for corono radicular stabili?ation of pulpless teeth. They consist of /oven fibre ribbons. 8sed as a matri5 for the construction of direct etch < retained composite splints. Ribbond suggested that the /oven polyethylene fiber can also be used to construct and directly place composite post and core. Removal of the obturation material and a minimal amount of dentin to facilitate insertion of the ribbon is the only preparation re!uired. Cne or more length are coated /ith bonding agent: folded into a -1shape around an instrument and then carried into the canal space to be cured. Additional increments are then added to complete the core build up. *d anta"es 1. Compared to preformed posts: there is no additional tooth removal after endodontic treatment. This maintains the natural strength of the tooth. . Eliminates the possibility of root perforation. #. Fecause it is made /hen the Ribbond is in a pliable state: it conforms to the natural contours and undercuts of the canal and provides additional mechanical retention. '. There are no stress concentrations at the tooth1post interface. ). The Ribbond post and core is passive and highly retentive. Disad anta"es 1. $pecial scissors re!uired to cut the fibers

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#IG$T % TRANSMITTING POSTS Translucent posts @light post and luscent archorA have been introduced in order to allo/ the use of light cured luting agents. This can facilitate cement placement and evaluation of post seating prior to setting. The original purpose of these posts /as to provide a means of reconstituting roots /ith overly flared canals caused by caries or e5cessive endodontic preparation: the aim being to achieve union bet/een the remaining: dentine and a light cured composite: thereby restoring the lost bul= and original strength of the root. The plastic posts re!uire a diameter greater than 1.)mm to achieve complete curing to a depth of over +mm. The relative ability of the glass fibre versions to transmit light has not yet been reported.

T>IN L-SCENT *NCHO#S ) This innovative design is visible assurance against accidental debonding of adhesive and resin1core materials. The slim mid1section creates a 9physical cho=e;. The vent groove eliminates air resin entrapment and prevents rotational dislocation. &t all adds upto a /inning combination of light transmission: attractive esthetics and t/ice the retention. Li"ht transmittin" ) Effectively polymeri?es composite /ithin the deep confines of canals. Esthetics ) Eliminates shado/s at the gingival: root and cro/n interface as /ell as through thin1laminate composite restorations.
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Reflects the surrounding colors and hues: compatible /ith natural esthetics. Mono'!oc stren"th ) (ight or dual cure composites bonds to the fiberglass reinforced anchors creating a cohesive: very strong foundation for restorations. Narrow radia! midsection ) 0echanical resistance seen in the anchorIs midsection provides double retention against accidental debonding of resins and restorative materials. Dou'!e6end a!ternati es ) The anchor cone shaped1end can be placed in deeper and narro/er canals /ithout e5cess removal of dentin or canal /all. The parallel end can be alternatively placed into long: /ider canals of teeth. The parallel canals can be refined /ith drills: used in parallel canal post techni!ues. Lon"itudina! ent6"roo e) Eliminates trapped air bubbles in the surrounding causing porosity: for completely filling the canal. Additionally: the vent1 groove creates an antirotational resistance polymeri?ed resin material. Low modu!us of e!asticity <2;.1 3$a5 ) The AnchorIs elasticity in the range of healthy teeth: provides safety and cohesive resistance to impact. &!e?ura! Stren"th <FG8 M$a5) The T/in Anchors /ithin the rang of healthy teeth are outperforming metal posts.

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T>IN6L-SCENT ST*#TE# KIT Available in # diameters to fit large and very slim canals. 1) t/in luscent anchors @) of each si?e: small: medium: largeA # corresponding si?e reamers 1 pathfinder 1 probos && router 1) forms to fit

DO-,LE T*PE# POST S.STEM <D.T POST5

The capacity of different types of post1and1core to protect the prosthetic restoration from biomechanical failures varies greatly. Post1to1 canal adaptation represents an important element in the biomechanical performance of the prosthetic restoration. The ne/ %T1 Post system /as designed /ith the purpose of providing close canal adaptation /it minimal tooth structure removal. The %T1 Post system seem to offer a logical solution in restoring endodontically1treated teeth. %.T. Post provides bigger taper at the coronal level.
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A better adaptation at the coronal level increases the amount of the fiber1epo5y high performance material: therefore: conse!uently decreases the thic=ness of the resin cement: a lo/er performance material: and reduces its polymeri?ation total shrin=age.

%.T post combines the conservative aspect of Endo1 composipost 80 apically: and the greater si?e of the Composipost coronally. The post is fabricated /ith a prestressed glass fiber system due to

/hich it can resist more than 1:BB:BB:BBB cycles in a fatigue resistance test: in /hich the closest competition could only ta=e 1:+#:BBB cycles.

T#*NSILL-MIN*TIN3 L-MINEC POST S.STEM ) A user friendly: single office visit solution for restoring compromised thin1/illed roots /ith strong adhesive materials. All too often: fragile: thin1/alled teeth present ma3or restorative problems E cast posts or e5tractions /ere often the only alternative. Fut today: there is a user friendly: single office visit solution to this problem. The clear light transmitting posts polymeri?e light1cured composites /ithin the entire root canal. After curing: the (80&NES post is removed: leaving a ready canal for a corresponding classic post. retention. Reinfroced root strength E (ight1cured composites internally reinforce the root structure providing ma5imum sheer load support and

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&mproved control E (ight1curing composites are easy to control: more adaptive: and safer than auto1cured composites that may prematurely harden.

Centered canal position E The lumine5 post techni!ue centers the canal and forms a selected si?ed: full length parallel sided canal for corresponding dentatus classic metal posts.

$uperior aesthetics E The light1cured composite inside the canal mas=s metal posts /ith a reflective tooth colored foundation for modern restorations.

Techni!ue versatility E (umine5 smooth and grooved posts may be also used as an impression and castable post pattern in the direct and indicrect fabrication of posts.

$uperior delivery system E $election of (umine5 and metal posts in all si?es along /ith corresponding reamers and components are pac=aged in the refillable: easy to use dispenser.

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ST#ESS *N*L.SIS &O# POST *ND CO#E

Restoration of the pulpless tooth is critical for successful endodontic therapy. The nature of force e5isting in teeth and surrounding tissues has been a sub3ect to investigation by dental researcher for a century or more. As techni!ue has developed for increasingly radical restorations of damaged teeth: interest has naturally e5panded to include stresses induced in reconstructed teeth in function. 6no/ledge of the =inds of stress normal dental structures must /ithstand and therefore restored structures should /ithstand is of obvious value. The ability to perform stress analysis on reconstructed teeth is of substantial importance in optional prosthesis designs. Stress ana!ysis methods used) 1. Photoelastic stress analysis . Finite element stress analysis

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#EMO0*L O& ECISTIN3 POSTS Cccasionally the dentist is confronted /ith an endodontically treated tooth /ith a poor prognosis because of the fractured do/el. Retreatement /ith a post and core cannot be attempted unless the fractured post is removed. The techni!ues D instruments currently available to remove a post D core include 1. 0asserann techni!ue . the (ittle giant post puller #. 6anematsu do/el removing plier '. $.$ 7hite post e5tractor ). post puller *. 2onon post removing system +. $aca Pino post e5tractor ,. 8ltrsonics Masserann Procedure ) The appropriate si?e trepan bur is determined by a gauge supplied in the =it. The trepan bur is turned by hand: cutting a small trench around the post. After proceeding from one third to one half the /ay do/n the post: the trepan bur is replaced /ith the ne5t smaller si?e: /hich /ill grip the end of the post to lift it out of the canal. &f necessary: the trepans can be used to e5tend to the bottom of the post for easy removal. *d anta"es ) 1A &t is simple: A (ittle heat is generated: #A There is no danger of pushing fragments further into the root: and

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'A E5cessive forces are eliminated /ith little chance of perforation or splitting the root. This techni!ue may ma=e it possible to save strategic teeth that other /ise might be lost. Litt!e "iant $ost $u!!er This instrument can remove a post safely because it grasp the do/el firmly for removal /hile the studs of the instrument support the tooth. >o/ever: there are conditions in /hich the instrument cannot be applied. These include 1. A discrepancy in the level of the remaining tooth structures: particularly on the mesial and distal portion. . Thin mesial and distal remaining tooth structure and brittleness of endodontically treated teeth. #. Remaining tooth structure is too small for the studs to support.

Kanematsu dowe! remo in" $!ier This is applier /ith a modified /or=ing end thus enabling a firm grasp on the e5posed do/el. Counter rotational force is applied onto the post to facilities its removal.

SS white $ost e?tractor This is also a modified plier in the same mode as the =anematsu do/el removing plier. Post $u!!er 7arren and 2utman have described a simplified techni!ue for post removal using a post puller. The post and tooth are reduced to allo/ for attachment of the post puller. The first set of 3a/s push puller are securely fasten onto the post /hile the second set of 3a/s push a/ay from the tooth in line /ith the long a5is of the tooth lifting the post out of the canal.

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The advantages of this system include conserving root structure and reducing the ris= of root fracture: root perforation and root tor!uing. 3onon $ost remo a! techni(ue ) Pierre 0achtou: Philippe $arfati and Anna 2enevieve presented the 2onon post removing system for removing posts from the root canals prior to endodontic retreatment. The principle of this instrument is comparable to a cor= scre/. The post and the tooth are separated by pitting the tooth against the post and creating enough force to overcome the bond. 1A The first step is to free the head of the post from the coronal tooth structure. All restorations including cro/ns must be removed. Circumferential prereduction of the core may be achieved using a tapered diamond bur at high speed. A An ultrasound device is useful to vibrate the post and disintegrate the cement. #A &n order to facilitate the centering of the trephine: a special bur included in the 2onon =it is used to taper the protruding head of the post. 'A The high strength trephine is used to bore and gauge the protruding post to the e5act si?e of a corresponding mandrel /hich is specially manufactured to thread the post. )A Fefore the mandrel is scre/ed onto the post: three rings are positioned onto its shan=. This acts to cushion the mandrel and to spread the forces onto the root surface as the post is being e5tracted. *A The e5tracting pliers are fi5ed on the mandrel and the 3a/s of the pliers are e5panded by tightening the =nurled =nob. This procedure /ill separate the post from the tooth !uic=ly and safely facilitating endodontic retreatment. $ometimes the space bet/een the ad3acent teeth is smaller than the /idth of the 3a/s. This problem may be resolved by slipping a hollo/ tube included in the pac=age into the 9long; threaded mandrel.

Saca $ino $ost e?tractor The design of the saca pino e5tractor may be li=ened to that fan e5traction forceps. The angled head permits access to every tooth in the mouth. The 3a/s of the instrument grip the post securely so that the instrument does not sip as the post is being unseated. The dentist has directed control over the amount of force used to grip the core and remove the post: /hich reduces the danger of root fracture. 8ltrasound 8ltrasound had been advocated as an aid in the removal of fractured files: silver cones and posts from the root canal. &ts application in post removal is related to the fact that ultrasonic /aves are transmitted through the post and brea= the cement seal: thus facilitating removal. Advantage 1. conserving the remaining tooth structure . avoiding root perforation #. minimi?ing fracture ris=s '. saves time

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#E0IE> O& LITE#*T-#E

&!emin" Isidor et al evaluated the fracture resistance of bovine teeth /ith prefabricated carbon fiber posts. The results of this study /ere compared to a previous study conducted by the authors that had been conducted under similar condition /ith prefabricated parallel sided posts @Para postA and tapered: individually cast post. The failure rates of the /ere significantly higher than those of the carbon fiber1.. #o'ert > Loney et al studied the effect of load angulation on the fracture resistance of the teeth restored /ith cast post and core and cro/ns. They sub3ected the prepared specimens to the loads at 11B: 1#B and 1)B to the long a5is of the tooth. 0ean failure loads increased as load angle approached parallelism to the long a5is of the teeth. The results sho/ed significant difference in fracture resistance of post restored teeth can occur as a result of load angle. @&LP 1..) ,: '+1 )1A),. Lennart Mo!!ersten et al studied the comparison of strengths of five post and core systems for root filled teeth: Composi post: carbon fiber do/els and gold alloy posts and cores: for vital teeth glass ionomer cement /ith threaded parapulpal retention pins: resin composite /ith threaded parapulpal retention pins and gold alloy /ith parallel parapulpal pins /ere tested. They concluded that Composi post and cores and cast gold posts and cores /ere e!uivalent in strength and did not vary significantly from gold cores constructed on vital teeth. @G.& BB : ##::1'B11''A' . D.3 Purton and 7.* Payne compared carbon fiber and stainless steel root canal posts. They concluded that carbon fiber post appeared to have ade!uate rigidity for their designed purpose. The bond strength of the resin composite cores to the carbon fiber posts /as significantly less than that of the stainless steel post. @G.& 1..*: +:.#1.+A)#. EriH *smussen et al studied stiffness: elastic limit and strength of ne/er types of endodontic posts. They concluded that ceramic posts /ere very stiff and strong: /ith no types of post from the previous study i.e parallel sided post and tapered: individually cast post

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plastic behavior. The titanium post /as as strong as: but less stiff than the ceramic posts. Composi post had the lo/est values of stiffness: elastic limit and strength of the post investigated. @LC% 1...: +: +)1 ),A1+. >i!!iam *.Sau$e et el compared the fracture resistance bet/een morphologic do/el and cores and a resin reinforced do/el system in the intraradicular restoration o f structurally compromised roots. The resistance to a stimulated masticatory load of a resin re1inforced post and core system /as significantly greater than that of a morphologic post and core procedure,B. ,ret I.Cohen et al determined the fracture load of four core material supported by five post designs. They concluded that for all post Tytin silver amalgam and Ti1core material /ere significantly stronger than =etac1silver and 21C 0iracle mi5 material.@LP% 1..*M+*:',+1.)A11.

3io anni E. Sido!i et al @1..+A 1 Compared failure characteristics of Composi post core system: $tainless steel post and composite core: and cast gold post and core. The Composi post system e5hibited inferior strength properties in comparison to other post and core systems '. *rturo Martine+6Insua et al @1..,A# Compared the fracture resistance of pulpless teeth restored /ith a cast post and core and carbon fiber post /ith a composite core. The results revealed that teeth restored /ith cast gold posts and core recorded a higher fracture threshold than teeth restored /ith carbon fiber post). 7ohn.P.Dean et al @1..,A evaluated the influence of endodontic and restorative procedures on fracture resistance of teeth and compared the incidence of root fracture in teeth /ith clinical cro/ns removed that /ere restored /ith three different types of post and a composite core build1up. They concluded that tooth /ith post and composite build ups failed at significantly lo/er forces than teeth in /hich cro/ns had not been removed.

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Teeth restored /ith stainless steel posts demonstrated )BH incidence of root fracture: /here as those restored /ith carbon fiber post and composite core had no root fracture1'.

C.7 Cormier et al @ BB1A1 Evaluated the fracture resistance: failure mode and retrievability of si5 post systems at four simulated clinical stages of tooth restoration. The titanium parapost had greater resistance to failure and caused greatest number of unfavourable root fracture than other post systems. The fiber posts /ere an improvement over conventional posts in terms of root fractures and retrievability of posts1'. Chirsto$he 3. #ay"ot et al @ BB1A1 Evaluated fracture resistance and mode of fracture of endodontically treated incisors restored /ith cast post and core: prefabricated stainless steel post and carbon fiber reinforced composite post systems. The use of carbon fiber1 reinforced composite posts did not change the fracture resistance or the failure mode of endodontically treated teeth compared to the use of metallic post1 . Pau!o. C. *. Maccar! et al @ BB#A1 Evaluated the role of composition of prefabricated esthetic posts in fracture resistance of endodontically treated teeth. Post systems utili?ed /ere Astheti1Post: Fiber6or Post and Cosmo Post. They concluded that the fracture strength of Cosmo Post /as significantly lo/er than that of the other posts. Ceramic posts: carbon1fiber prefabricated esthetic post provided endodontically treated /ith higher fracture resistance.

.un6Hsin6Hu et al @ BB#A1Evaluated the fracture resistance of endodontically treated anterior teeth restored /ith four post and core systems. The results sho/ed no significant difference in the failure loads among different post and core systems but root fracture /as detected in the group restored /ith ceramic post and resin composite cores.

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N 0ELM-#-3*NI A P *#*MESH> *#*N <2;;=5 1 %escribed single sitting chair side procedure for fabrication of custom made resin post and core. They concluded that fabricating a custom1made resin post and core is easier: time saving: economical: esthetically compatible and bonds to the root dentin resulting in a single monobloc,B.

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CONCL-SION) Endodontic therapy is an essential component of the practice of restorative dentistry at the close of the B th century. %ental practice and its success are ine5tricably tied to the !uality of the restoration. Fefore ma=ing a treatment decision: the restorative dentist must evaluate the !uality of endodontic treatment: the periodontal support available: and the status of the remaining tooth structure. The subse!uent restoration for the endodontically treated tooth is function of the remaining tooth structure: the shape and configuration of the canals: and the functional and esthetic demands on the tooth. Arriving at the best solution is a comple5 process: affected by many different variables: including available post systems and restorative foundation materials. Although there are additional e5perimental laboratory data on /hich to base a restorative decision: long1term controlled clinical data are not yet available. Restoring the endodontically treated tooth remains one of the most challenging problems facing the restorative dentist. An uncomplicated and systematic decision ma=ing process: based on universally accepted philosophy and techni!ues: is necessary to ma5imi?e chances for a successful restorative outcome. &f certain basic principles are follo/ed in the restorative of endodontically treated teeth: it is possible to achieve high levels of clinical success /ith most of the current restorative systems. These principles includeE

Avoid bacterial contamination of the root1canal system. Provide cuspal coverage for posterior teeth. Preserve radicular and coronal tooth structure. 8se posts /ith ade!uate strength in thin diameters Provide ade!uate post length for retention 0a5imi?e resistance from including an ade!uate ferrule 8se posts that are retrievable.

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,i'!io"ra$hy )
1. Albu!uer!ue R%C: Palleto (T%A: Fontana R>FT$: Cimini CA Lr. $tress analysis of an upper central incisor restored /ith different posts. L Cral Rehabil BB#M #BE .#*1.'#. . A=soy 2: Cotert >$: 6or=ul (. Effect of an adhesive resin luting agent as the do/el head retention of three different core materials. L Posthet %ent. 0ayM.#@)AE'#.1'). #. Al1harbi F: Nathanson %. &n -itro assessment of four esthetic do/els to resin core foundation and teeth. L Prosthet %ent BB#M .BE )'+1))). '. Arora C: $ingh R6: Chitre -: Aras 0. Fiomechanical considerations in the restoration of Endodontically treated teeth /ith post and core. L. &nd . Prosth. $oc BB#M #E '11'). ). Arturo 0artine?1 &nsua: (uis %a $ilva: Fenito Rilo:8rbano $antana. Comparison of the fracture resistances of pulpless teeth restored /ith a cast post and core or carbon1 fiber post /ith a composite core. Lournal of Prosthetic %entistry 1..,M ,BE ) +1)# . *. Ayna E: Celen= $. 8se of an alternative pontic foundation techni!ue for a fibre reinforced composite fi5ed partial dentureE a clinical report. L Prosthet %ent. BB) 0ayM.#@)AE'1 1). +. Fro/n P(: >ic=s N(. Rehabilitation of Endodontically Treated Teeth using the Radiopa!ue Fiber Post. Compend Contin Edu %ent BB#M 'E +)1 ,'. ,. Furanadham $: A!uilino $A: $tanford C0. Relation bet/een %o/el E5tension and Fone (evel in Anterior Teeth. L %ent Res 1...M +,E endodontic post. Guintessence &nt 1.,+M 1,E '#11'#). 1B. Cheung 7. A revie/ of management of endodontically treated teeth. Post: core and final restorations. L Am %ent Assoc BB) 0ayM1#*@)AE*111.. 11. Carvalho CA: -alera 0C: Cliveira (%: Camargo C>. $tructural resistance in immature teeth using root reinforcement is vitro. %ent Traumatol. LunM 1@#AE1))1.. BB) @abstract .#BA. .. Caputo AA: >o=ama $N. $tress and retention properties of a ne/ threaded BB)

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1 . Christophe 2 Raygot: Lohn Chai: (ee Lameson. Fracture Resistance and Primary Failure 0ode of Endodontically Treated Teeth Restored /ith a Carbon Fiber1 Reinforced Resin Post $ystem &n -itro. &nternational Lournal of Prosthodontics BB1M 1'E 1'111'). 1#. Cohen F&: Pagnillo 06: Ne/man &: 0usi=ant F(: %eutsch A$. Retention of a core material supported by three post head designs. L Prosthet %ent BBBM ,#E * '1 * ,. 1'. Cohen $: Furns RC. Path/ays of the Pulp. , th Edn. $t. (ouis E Cv 0osbyM 1..'. p. +*.1+.1. 1). C L Cormier: % R Furns: P 0oon. &n vitro comparison of the fracture resistance and failure mode of fiber: ceramic: and conventional post systems at various stages of restoration. Lournal of Prosthodontics BB1M 1BE *1#*. 1*. %ean LP: Leansonne F2: $ar=ar N. &n -itro evaluation of a Carbon Fiber Post. L Endod 1..,M 'E ,B+1,1B. 1+. %eliperi s: Frad/ell %N: Coiana 2. Reconstruction and devital teeth using direct fiber reinforced composite resinsE a care report. L Adhes %ent. summer:+@ AE1*)1+1. 1,. %eutsch A$: Cavallari L: 0usi=ant F(: $ilverstein (: (epley L: Petroni 2. Root fracture and the design of prefabricated posts. L Prosthet %ent 1.,)M )#E *#+1*'B. 1.. Ertugrual >4: &smail U>. Anvitro comparison of cast metal do/el retention using various luting agent and tensile loading. L Prosthet %ent. BB) 0ayM.#@)AE''*1) . B. Eri= Asmussen: Anne Peut?feldt: Thomas >eitmann. $tiffness: elastic limit and strength of ne/er types of endodontic posts. Lournal of %entistry 1...M +E +)1 +,. 1. Fo==inga 7A: (e Fell A0: 6reulen C0: (assila (-: -allittu P6: Creugers N>. E5 vivo fracture resistance of fracture resistance of direct resin composite complete cro/ns /ith and /ithout posts on ma5illary premolars. &nt Endod L. BB) AprM#,@'AE# B1+. . Freedman 2A. Esthetic Post1And1Core Treatment. %ent Clin North Am BB1M ')E 1B#111*. BB)

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#. Flemming &sidor: Per Cdman: 6nud Frondum. &ntermittent loading of teeth restored using prefabricated carbon fiber posts. &nternational Lournal of Prosthodontics 1..*M .E 1#111#*. '. 2alvan R&: Robertello FL: (ynde TA. &n vitro comparison of fluoride release of si5 direct core materials. L Prosthet %ent BBBM ,#E * .1*##. ). 2oldrich N. Construction of posts for teeth /ith e5isting restorations. L Prosthet %ent 1.+BM #E 1+#11+*. *. 2ardon 0P. The removal of gutta1percha and root canal sealess from root canals. N4 %ent L. BB)M1B1@ AE''1) . +. 2iovanni E $idoli: Paul A 6ing: %erric= L $etchell. An in vitro evaluation of a carbon fiber based post and core system. Lournal of Prosthodontics 1..+M +,E ) 1.. ,. 2oracci 2: Raffaelli C: 0onticelli %F: Falleri F: Festelli E: Ferrari 0. The adhesion bet/een prefabricated FRC. Posts and composite resin coresE 0icrotensile bond strength /ith and /ithout post < silani?ation. %ent 0ater. BB) 0ayM 1@)AE'#+1''. .. 2oss L0: 7right 7L Lr: Fo/les 7F. Radiographic appearance of titanium alloy prefabricated posts cemented /ith different luting materials. L Prosthet %ent 1.. M *+E *# 1*#+. #B. 2u?y 2E: Nicholls L&. &n -itro Comparison of intact endodontically treated teeth /ith and /ithout endo1post reinforcement. L Prosthet %ent 1.+.M ' E #.1'#. #1. >all %(: 7illiams -0. Cro/n repair /ith a cast post and core. L Prosthet %ent 1.,)M )#E *'11*' . # . >anson EC: Caputo AA. Cementing mediums and retentive characteristics of do/els. L Prosthet %ent 1.+'M # E ))11))+. ##. >edlund $C: Lohansson N2: $3ogren 2. Retention of Prefabricated and &ndividually cast root canal posts in -itro. Fr %ent L BB#M 1.)E 1))11),. #'. >oag EP: %/yer T2. A Comparitive evaluation of three post and core techni!ue. L Prosthet %ent 1., M '+E 1++11,1. #). &ngle L&: Fa=land (6. Endodontics. 'th ed. Faltimore E 7illiams and 7il=insM 1..'E p. ,,B < . B.

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#*. &!bal 06: Lohansson AA: A=eel RF: Fergenholt? A: Cmar R. A Retrospective Analysis of factors associated /ith the Periapical $tatus of Restored: Endodontically Treated Teeth. &nt L Prosthodont BB#M 1*E #11#,. #+. Lacoby 7E Lr. Practical techni!ue for the fabrication of a direct pattern for a post1 core restoration. L Prosthet %ent 1.+*M #)E #)+1#*B. #,. Lames ( 2utmann. The dentin1root comple5E Anatomic and biologic considerations in restoring endodontically treated teeth. Lournal of Prosthetic %entistry 1.. M *+E '),1'*+.6arapanou -: -era L: Cabrera P: 7hite RR and 2oldman 0. Effect of &mmediate and %elayed Post Preparation on Apical %ye (ea=age using T/o different sealers. L Endod 1..*M E ),#1),). #.. 6ing PA: $etchell %L: Rees L$. Clinical evaluation of a carbon fibre reinforced carbon endodontic post. L Cral Rehabil BB#M #BE +,)1+,.. 'B. 6outayas $C: 6ern 0. All1ceramic posts and cores E The state of the art. Guintessence &nt 1...M #BE #,#1#. . '1. 6rupp L%: Caputo AA: Trabert 6C: $tandlee LP. %o/el retention /ith glass1 ionomer cement. L Prosthet %ent 1.+.M '1E 1*#11**. ' . 6vist T: Rydin E: Reit C. The Relative Fre!uency of periapical lesions in teeth /ith Root Canal Retained Posts. L Endod 1.,.M 1)E )+,1),B. '#. 6/an E>: >arrington 27. The effect of immediate post preparation on apical seal. L Endod 1.,1M +E # )1# .. ''. (arato %C. $ingle 8nit cast post cro/n for pulpless anterior tooth roots. L Prosthet %ent 1.**M 1*E 1')11'.. '). (e/is R: $mith F2N. A clinical survey of failed post retained cro/ns. Fr %ent L 1.,,M 1*)E .)1.+. '*. (ennart 0ollersten: Paul (oc=o/andt: (ars1 A=e (inden. BB M ##E 1'B11'.. '+. (loyd P0: Pali= LF. The philosophies of do/el diameter Preparation E A (iterature revie/. L Prosthet %ent 1..#M *.E # 1#*. ',. 0achtou P: $arfati P: Cohen A2. Post Removal prior to Retreatment. L Endod 1.,.M 1)E )) 1))'. A comparison of strengths of five core and post1and1core systems. Guintessence &nternational

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'.. 0alferrari $: 0onaco C: $cotti R. Clinical Evaluation of Teeth Restored /ith Guart? Fiber1Reinforced Epo5y Resin Posts. &nt L Prosthodont BB#M 1*E #.1''. )B. 0e=ayara33ananonth T: 6iat1amnuay $: $alinas TL. A combined direct do/el and indirect core techni!ue. Guintessence &nt BBBM #1E 1.1 #. )1. 0e??omo E: 0assa F: (ibera $%. Fracture resistance of teeth restored /ith t/o different post1 and1core designs cemented /ith t/o different cements E An in vitro study. Guintessence &nt BB#M #'E #B11#B*. ) . 0ilot P: $tein R$. Root fracture in endodontically treated teeth related to post selection and cro/n design. L Prosthet %ent 1.. M *,E ' ,1'#). )#. 0onticelli F: 2randini $: 2oracci C: Ferrari 0. Clinical Fehavior of Translucent1 Fiber PostsE A 1year prospective study. &nt L Prosthodont BB#M 1*E ).#1).*. )'. Cliva RA: (o/e LA. %imensional stability of composite used as a core material. L Prosthet %ent 1.,*M )*E ))'1)*1. Paulo C A 0accari: E/erton N Conceicao: 0auro F Nunes. Fracture resistance of endodontically treated teeth restored /ith three different prefabricated esthetic posts. Lournal of Esthetic Restorative %entistry BB#M 1)E )1#). )). Perel 0(: 0uroff F&. Clinical criteria for posts and cores. L Prosthet %ent 1.+ M ,E 'B)1'11. )*. Pilo R: Tamse A. Residual dentin thic=ness in mandibular premolar prepared /ith 2ates 2lidden and Parapost %rills. L Prosthet %ent BBBM ,#E *1+1* #. )+. Preis=el >7. Cverdentures 0ade Easy < A guide to &mplant and Root supported prostheses. Guintessence: Chicago 1..*. p. ')1**. ),. Purton %2: Chandler NP: Gualtrough ALE. Effect of thermocycling on the retention of glass1fiber root canal posts. Guintessence &nt BB#M #'E #**1#*.. ).. Purton %2: Payne LA. Comparison of Carbon fiber and stainless steel root canal posts. Guintessence &nt 1..*M +E .#1.+. *B. Gualtrough ALE: Chandler NP: Purton %2. A comparison of the retention of tooth < colored posts. Guintessence &nt BB#M #'E 1..1 B1. *1. Rolf 6C: Par=er 07: Pelleu 2F. $tress Analysis of five prefabricated Endodontic %o/el %esigns E A Photoelastic study. Cper %ent 1.. M 1+E ,*1. .

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* . Rosenstiel $F: (and 0F: Fugimoto L. Contemporary Fi5ed Prosthodontics: # rd Edition. $t (ouis E 0osby: BB1. p. + 1#1 . *#. Robert 7 (oney: Ron 2 Ritsco. The effect of load angulation on fracture resistance of teeth restored /ith cast post and cores and cro/ns. &nternational Lournal of Prosthodontics 1..)M ,E '+1 )1. *'. $aupe 7A: 2lus=in A>: Rad=e RA Lr E A comparative study of fracture resistance bet/een morphologic do/el and cores and a resin1reinforced do/el system in the intraradicular restoration of structurally compromised roots. Guintessence &nt 1..*M +E ',#1'.1. *). $ahafi A: Peut? Feldt A: Ravholt 2: Asmussen E: 2otfredsen 6. Resistance to cyclic loading of teeth restored /ith posts. **. $eo/ ((: Ton C2: 7ilson N>. Remaining tooth structure associated /ith various preparation designs for the endodontically treated ma5illary second premolar. Eus L Prosthodont Restor %ent. BB) LunM 1#@ AE)+1*'. *+. $hillingburg >T: 6essler LC. Restoration of the Endodontically treated tooth. ChicagoE Guintessence: 1., . *,. $idoli 2E: 6ing PA: $etchell %L. An in vitro evaluation of a carbon1fiber1based post and core system. L Prosthet %ent 1..+M +,E )1.. *.. $irimani $: Riis %N: 0organo $0. An in vitro1study of the fracture resistance and the incidence of vertical root fracture of pulpless teeth restored /ith si5 post1 and1core systems. L Prosthet %ent 1...M ,1E * 1 *.. +B. $orensen LA: Engelman 0L. Effect of post adaptation on fracture resistance of endodontically treated teeth. L Prosthet %ent 1..BM *'E '1.1' '. +1. $orensen LA: Engelman 0L. Ferrule design and fracture resistance of endodontically treated teeth. L Prosthet %ent 1..BM *#E ) .1)#*. + . $orensen LA: 0artinoff LT. Endodontically treated teeth as abutments. L Prosthet %ent 1.,)M )#E *#11*#*. +#. $tern N: >irshfeld 4. Principles of preparing endodontically treated teeth for do/el and core restorations. L Prosthet %ent 1.+#M #BE 1* 11*). +'. $trassler >E: Cloutier PC: A Ne/ Fiber Post for Esthetic %entistry. Compend Contin Edu %ent BB#M 'E +' 1+)#.

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+). summit +*. Tait C0: Richetts %N: >iggins AL. 7ea=ened anterior roots1intra radicular rehabilitation. Fr %ent L. BB) 0ay ,M1.,@1BAE*B.11+. ++. Tidmarsh F2. Restoration of endodontically treated posterior teeth. L Endod 1.+*M E #+'1#+). +,. To=savul $: Toman 0: 8yolgan F: $chmage %: Nergi? &. Effect of luting agents and reconstruction techni!ues on the fracture resistance of pre1fabricated post systems. L Cral Rehabil. BB) LunE# @*AE'##1'B. +.. -ermilyea $2: 2ardner F0: 0oergeli LR. Composite do/els and cores E Effect of moisture on the fit of cast restoration. L Prosthet %ent 1.,+M ),E ' .1'#1. ,B. N -elmurugan: A Parames/aran. Custom10ade Resin Post and Core. Cperative %entistry BB'M .E11 111'. ,1. 7eins F$. Endodontic Therapy. )th Edn. $t (ouis. 0o E 0osby Uearboo=M 1.+* p. ++B1++1. , . 7illershousen F: Te=yatan >: 6rummenauer F: Friseno 0arro!uin F. $urvival rate of endodontically treated teeth in relation to conservative v"s post insertion techni!ues a retrospective study. Eur L 0ed Res. BB) 0ay BM1B@)AE B'1,. ,#. 7illiams -%: F3orndal A0. The 0asserann techni!ue for the removal of fractured posts in endodontically treated teeth. L Prosthet %ent 1.,#M '.E '*1',. ,'. 7illiam A $aupe: Alan > 2lus=in: Ryle A Rad=e. A comparative study of fracture resistance bet/een morphologic do/el and cores and a resin1reinforced do/el system in the intraradicular restoration of structurally compromised roots. Guintessence &nternational 1..*M +E ',#1'.1. ,). Uolds C: A=ova: 8ysal >. An e5perimental analysis of stress in simulated flared root canals sub3ected to various post core applications. L Cral Rehabit. BB) LunM# @*AE' +1# . ,*. Uun1>sin >u: &o= Chao Pang: Chii Chih >su: Uau1>ang (au. Fracture resistance of endodontically treated anterior teeth restored /ith four post1 and1 core systems. Guintessence &nternational BB#M #'E #'.1#)#.

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,+. 4mener C. Effect of do/el preparation on the apical seal of endodontically treated teeth. L Endod 1.,BM *E*,+1*.B.

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