Parul Agarwal, B.D.S., M.S. Michael Linebaugh, D.D.S., M.S. Scott Joslin, R.D.H. Cast Post and Core The cast post and core is utilized in situations when inadequate coronal tooth structure remains to support a crown. The cast post and core utilizes the retention available in the canal space remaining post endodontic treatment. As the retention of the CPC is achieved through cement contact to internal canal surface area, it is still necessary to have adequate ferrule of 3mm to support the crown. Armamentarium Crown and Bridge cassette Including GC Pattern Resin Endo cassette Including Gates Glidden setup High and Low speed handpieces Parapost Kit Torch NaOCl and Syringe Cast post and core There are several steps to the fabrication of the cast post and core. Depending on the situation, other steps may also be necessary Canal Preparation Resin pattern fabrication Finishing and cementation of the post and core Cast post and core Canal Preparation The tooth was prepared for a crown, note that all of the unsupported tooth structure and coronal undercuts were removed. Cast post and core: Canal Preparation A pre-operative radiograph is needed to determine the length of the canal Remember that it is imperative to allow 4-5mm of remaining Gutta Percha apically Also look for canal curvatures as they will not be able to be negotiated in the post preparation Cast post and core: Canal preparation Once the length of post preparation is determined, canal preparation is needed Several methods exist for preparation Warm Instrument Searing Peeso Reamers Gates Glidden Cast Post and Core Canal Preparation
Warm Instrument Searing Mark desired depth with and endodontic stopper An endodontic plugger is heated until it is glowing red The plugger is inserted into the canal with apical pressure When resistance is achieved the plugger should be rotated from side to side, to prevent pulling out all of the remaining gutta percha, and removed This should be performed until ineffective and followed with rotary instrumentation
Cast post and core: Canal preparation GatesGlidden drill Mark depth with endo stopper Place a drop of NaOCl in the canal for lubrication Begin preparation with bur spinning prior to canal entry DO NOT FORCE THE BUR, yield to resistance and reevaluate Cast post and core: Canal preparation Gates Glidden taken to length Remember the minimum width acceptable is a yellow post which corresponds to a #4 Gates Glidden Cast post and core: Canal Preparation Post preparation after removal of Gates Glidden Flush with NaOCl, take care if no isolation is in place as NaOCl is caustic
Cast post and core: Resin pattern fabrication Following space preparation, Fabrication of the resin pattern occurs A SERRATED plastic post or metal post can be used. When a plastic post is used, the pattern completely burns out, and the post is formed entirely in the casting alloy. When a metal post is used, molten alloy is cast around the post, which mechanically interlocks with previously developed notches to produce a rigid structure. Cast post and core: Resin pattern fabrication
The metal post is notched occlusally so that good interlocking with the core material can be achieved. Cast post and core: Resin pattern fabrication In this post and core fabrication a plastic post has been used. Note that the posts in both instances are the SERRATED variety, do not use the smooth posts Cast post and core: Resin pattern fabrication
Plastic post Cast post and core: Resin pattern fabrication GC Pattern Resin Cast post and core: Resin pattern fabrication When adding the GC Resin to the plastic or metal post, a salt and pepper technique is utilized For finer additions, the brush can be cut to a point with sharp scissors Cast post and core: Resin pattern fabrication
Cutting the brush to a point Cast post and core Resin pattern fabrication
Note the finer tip on the cut brush on the right Cast post and core Resin pattern fabrication Trying in the plastic post Cast post and core Resin pattern fabrication
Once the post is in place, grab it at the coronal most extent of the preparation with the cotton pliers, remove it and re-measure to confirm the post is fully seated Cast post and core Resin pattern fabrication
The preparation is cleaned and dried with air and paper points It is then lightly lubricated with petroleum jelly to prevent adhesion Cast post and core: Resin pattern fabrication
GC Pattern Resin application using the Salt and Pepper Technique Cast post and core: Resin pattern fabrication
Resin is added by the Salt and Pepper technique, dipping a small brush in a monomer and then into polymer and applying it to the post. Before it fully hardens, it is loosened and reseated several times. This is why it is important to leave the remaining coronal extent of the post. Cast post and core
The core is slightly overbuild and is let to polymerize fully. The shape of the pattern should resemble an ideal preparation and should be completely sealed at the apical margins. Cast post and core: Resin pattern fabrication The core is then shaped with a coarse diamond bur as if the tooth were being prepared for a crown. Water spray is used to prevent overheating of the acrylic resin. Be sure to keep pushing the core back in to place as they have a tendency to loosen. Cast post and core: Resin pattern fabrication
The resin pattern is removed and the excess plastic sprue is cut off Replace the Pattern to confirm all margins are closed Cast post and core: Resin pattern fabrication Resin pattern is then sent to the laboratory for sprueing and casting in the desired alloy. Laboratory Wait Time As the Cast post and Core is a Laboratory dependent procedure, a wait time is necessary while the lab fabricates the alloy core from the pattern Be sure to ask your lab how long they want for fabrication time.
Cast post and core: Finishing of the post and core Cast Post and Core returned from the lab Be sure to check for flashing and bubbles in the finished product as these may inhibit the CPC from fully seating Cast post and core: Finishing of the post and core Try in the CPC Check for Draw There should be no adhesions with insertion Marginal Fit Adjust as necessary until desired fit is achieved It is important that you make a mental note of the fit so that when you are cementing the CPC you have a reference to be sure it is adequately and completely seated Cast post and core: Cementation of the post and core Lentulospiral rotary paste fillers are used to fill the post space completely. It is important to fill all the dead space within the root canal system. Voids may be a cause of periodontal inflammation via the lateral canals. Cast post and core: Cementation of the post and core Required components for cementation Cast post and core: Cementation of the post and core Choose the cement to be used for seating the CPC Cast post and core: Cementation of the post and core Fuji Cem application Cast Post Core Cementation After assembling all of the cementation components, be sure to isolate the tooth and prepare/dry the canal as prescribed depending upon the type of cement you are using Be sure all of the temporary cement is removed from the canal and preparation as it may inhibit seating of the CPC or setting of the cement Cast post and core: Cementation of the post and core
The canal is dried with a paper point prior to cementation. Cast post and core: Cementation of the post and core Placement of the cement on the Lentulospiral Cast post and core: Cementation of the post and core
Place the CPC in the post space and apply apical pressure Clear the excess cement from the margin and check to make sure it is completely seated Cast post and core:
Clearing cement from the margin after cement setting Be sure not to disturb the post when the cement is setting as this may weaken the cement bond Cast post and core: Finished CPC Cast post and core:
Often, minor preparation may be needed after seating the CPC BE SURE the cement is completely set before doing this Cast post and core: Final restoration
Cast post and core: Cementation of the final restoration
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