OBSERVATIONS
GORDON J. CHRISTENSEN, D.D.S., M.S.D., PH.D.
POSTS AND CORES: STATE OF THE ART
Significant increases in the
use of crowns and fixed prostho-
dontic procedures have been as-
sociated with a need for more
posts and cores. Currently, most
dentists use prefabricated post-
and-core techniques,1 which are
faster, easier, less expensive
and, in most cases, less abusive
to teeth than custom-cast post-
and-core procedures.
This article discusses when
and under which conditions post-
and-core procedures are required
in pulpless teeth, the types of
posts in common use, current ce-
mentation procedures for posts,
core materials and antirotational
features for posts and cores and
subsequent crowns.
WHEN ARE POSTS
REQUIRED IN PULPLESS
TEETH?
This question is difficult to an-
swer, as there are so many clini-
cal variables related to the post-
and-core concept. Most post-and-
core research has been accom-
plished in vitro by evaluating
the tensile forces required to re-
move different types of posts.
Unfortunately, tensile forces on
posts are almost never encoun-
tered clinically, and transverse
(lateral) forces on posts and
cores are very difficult to evalu-
ate with in vitro tests. Carefully
controlled, long-term clinical in-
vestigations of different types of
post-and-core procedures are
lacking but sorely needed.
96 JADA, Vol. 129, January 1998
Copyright ©1998-2001 American Dental Association. All rights reserved.
When pulpless teeth have lit-
tle coronal suprabone tooth
structure remaining, it is sug-
gested that orthodontic extrusion
procedures, periodontal crown
lengthening or tooth removal
should be considered. Too often,
a post-and-core restoration is
placed, followed by a crown, only
to have the pulpless tooth crack
vertically after a few months or
years of service, thereby requir-
ing a disappointing, expensive al-
ternative procedure.
When tooth roots are hol-
lowed out with dental caries,
leaving only a thin 1-millimeter
collar of tooth structure coronal-
ly, the tooth should probably be
extracted. In such teeth, it is
difficult to determine if all cari-
ous tooth structure has been re-
moved, and these weakened
teeth have poor long-term ser-
vice potential.
Two major factors complicate
post-and-core strength needs:
heavy lateral occlusion, as en-
countered in bruxism, and the
use of pulpless teeth as fixed
prosthodontic abutments. Both
situations require extra strength
and resistance to transverse
loads, and when present, they
should influence dentists to
place posts in teeth that other-
wise might not need them.
Judging from the dental lit-
erature, and importantly from
the empirical evidence accumu-
lated by experienced restora-
tive-prosthodontic practitioners,
a tentative clinical conclusion
can be made. It appears that
when more than one-half of the
coronal tooth structure remains
on a pulpless tooth, a post-and-
core procedure is not needed.
However, if occlusion is expect-
ed to be heavy, the tooth is
planned to be a prosthesis abut-
ment or visible cracks are evi-
dent in the remaining tooth
structure, a post-and-core pro-
cedure should be carried out.
If less than one-half of the
coronal tooth structure is re-
maining on a pulpless tooth, it
is usually advisable to place a
post and core, thereby providing
adequate connection of the root
structure to the coronal core.
TYPES OF POSTS IN
COMMON USE
Composition. Post composi-
tion varies considerably today
and includes metal of various
types, fiber-reinforced compos-
ite, carbon fibers held together
with epoxy resin and ceramic.
Metal posts. Metal is used
most commonly. Metal composi-
tion includes nickel-chrome
(stainless steel), titanium alloy
(titanium, vanadium, alu-
minum) or pure titanium.
Although stainless steel is the
strongest, the potential for ad-
verse tissue responses to nickel
has stimulated most dentists to
use titanium alloy. The most
popular brands of metal posts
are Para-Post (Coltene/Whale-
 CHRISTENSEN

dent) and Flex-Post (Essential able. Some clinicians prefer mal use for this purpose is de-
Dental Systems). Pure titanium threaded posts, but nonthread- clining. Glass ionomer and resin-
is weakest but best in situations ed posts are used most today. reinforced glass ionomer are
in which the allergenic poten- The diameter of the most weaker than desirable for core
tial is undesirable or maximum coronal portion of posts should buildups, but these materials
strength is not needed (Filpost, closely approximate the pre- are excellent as fillers when less
Filhol Dental USA). pared root canal channel. Most than one-half of the coronal
Fiber-reinforced composite dentists extend the length of tooth structure is missing.
posts. When tooth-colored, non- the post occlusally through the
metal-containing crowns are build-up material. ANTIROTATIONAL
used, metal posts are contra- FEATURES FOR POSTS,
CORES AND CROWNS
indicated because of their color. CURRENT CEMENTATION
For esthetic reasons, white PROCEDURES FOR Posts in some parts of the mouth
POSTS
posts can be used, such as the are subjected to rotational forces,
Cerapost (Brasseler USA), Autocure resin cements dominate while others are not. Practi-
which is zirconia, or Ribbond this technique (Panavia 21, J. tioners can predict antirotational
(Ribbond Inc.) reinforcement Morita USA Inc., used with E.D. needs by observing occlusal con-
fibers placed into composite Primer, J. Morita USA Inc.). To tact areas. Antirotational fea-
resin that has been injected into increase retention of the post to tures can easily be placed in
the root canal. the resin cement, it is suggested tooth roots by slotting the most
Carbon fiber posts. Carbon that metal posts be sandblasted coronal internal position of the
fiber posts, now used successful- before cementation. Although the post channel or by placing “pot-
ly for nearly a decade (C-Post use of bonding agents prior to holes,” channels or retentive pins
by Bisco Dental Products), have post cementation appears to be a in the dentin mesially and distal-
satisfied dentists because of logical step, research reports vary ly to the post channel.
their strength and relative flexi- on the necessity for this step in The most important antirota-
bility, ease of placement or ease post channels. However, dentin tional feature for posts and
of removal, if necessary, for en- bonding materials that have been cores is placement of a ferrule
dodontic retreatment. Because placed in post channels cannot effect circumferentially around
of the black color of carbon avoid being placed on the coronal the buildup and remaining root
posts, they cannot be used in aspect of the root stump, thereby stump by extending crown prep-
clinical situations in which sub- providing a bond and seal in that aration margins at least 1 to 2
sequent non- location. millimeters apically to the com-
metal and posite tooth structure interface.
CORE MATERIALS
translucent
SUMMARY
crowns are Composite resin is used as the
planned. core material by most practition- Post-and-core placement using
Shape and ers.1 Autocure or dual cure is prefabricated posts and compos-
size. Although preferred, and Core Paste (Den- ite resin is an everyday proce-
Dr. Christensen is
co-founder and sen-
there is some Mat Corporation) and Ti-Cor dure in most general practices.
ior consultant of controversy (Essential Dental Systems) are Such posts are easily placed,
Clinical Research about the most the most popular brands. Any strong, relatively inexpensive
Associates, 3707 N.
Canyon Road, Suite
adequate material used as a composite and predictable. The most popu-
No. 7A, Provo, Utah shape of posts, buildup should be radiopaque, lar techniques and materials
84604, and is a
member of JADA’s
most research highly filled with glass filler for have been described. It is antici-
editorial board. He projects have strength, pigmented to demon- pated that post-and-core use
has a master’s de-
shown that strate the extent of the core and will continue to increase be-
gree in restorative
dentistry and a doc- parallel-sided easy to use. Dentists’ prefer- cause of the current trend to re-
torate in education posts or those ences for viscosity vary from rel- tain natural teeth into the ma-
and psychology. He
is board certified in
slightly ta- atively viscous to quite fluid. ture years of life. ■
prosthodontics. pered on their Amalgam is difficult and
1. Christensen RP, Christensen GJ. Product
Address reprint re-
apical end are time-consuming to use as a core use survey—1995. Clinical Research Associ-
quests to Dr.
Christensen. most accept- buildup, and its current mini- ates Newsletter 1995;19(10):3.

JADA, Vol. 129, January 1998 97

Copyright ©1998-2001 American Dental Association. All rights reserved.