Editor's note: Originally published in . Reviewed for clinical accuracy and formatting in .
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Q: I'm confused about the necessity of using posts in endodontically treated teeth. Some publications and speakers say that posts are always necessary, and others say they are never necessary. When, if ever, should posts be used, and what type of post should be used?
A: During my career to date, I have watched the use of posts and cores for endodontically treated teeth evolve from complicated, expensive, difficult to make, custom cast posts and cores, to metal prefabricated posts made from stainless steel, to titanium or titanium alloy, to today's popular fiber-reinforced resin-based composite. In my opinion, there have been numerous misunderstandings about the need or lack of need for posts.
I will discuss several factors to consider before making a decision about whether or not to place posts in endodontically treated teeth. My conclusions about posts are based not only on the research literature, which contains many excellent but sometimes confusing in-vitro studies on extracted teeth, but also my clinical experiences over many years as a practicing prosthodontist.
Many have stated that the main reason for placing a post is to strengthen the connection between the coronal build-up material or remaining tooth structure to the root portion of the tooth. In my opinion, that is only partially true. Additionally, the following potentially negative or positive factors should be considered in the decision to use a post. All of these factors should be observed before making the decision:
&#; Quantity of remaining tooth structure
&#; Quality of remaining tooth structure
&#; Remaining adjacent teeth
&#; Occlusion
&#; Planned restoration to be placed on the tooth
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Some teeth have most of the coronal tooth structure remaining after endodontic treatment, and others have very little tooth structure remaining. What is the significance of the amount of remaining tooth structure? For simplicity, I'll divide the discussion of remaining tooth structure into several categories, and I'll list them in decreasing order of clinical success:
All of the coronal tooth structure present except the endodontic access hole
If other negative factors (to be discussed later) are not present, such teeth usually do not require posts. After the endodontic procedure is completed, tooth colored resin-based composite should be bonded into the pulp chamber. These teeth usually continue to serve adequately as though they were vital teeth.
At least one-half of the coronal tooth structure remaining
This situation is one of the most common. Assuming the remaining coronal tooth structure does not have any of the negative characteristics discussed next, the occlusion is not heavy, and there are other teeth contiguous with the one being treated, this tooth may not need to have a post. The coronal tooth structure can be built up, usually with retentive resin-based composite build-up material, to provide additional retention for the subsequent restoration, and these teeth have excellent potential to serve uneventfully. However, if other negative factors are present, it is prudent to place a post.
Less than one-half of the coronal tooth structure remaining (Figs. 1-6)
It is my opinion, regardless of the other factors present, that it is still advisable to place a post or posts in such teeth. Endodontically treated teeth with less than one-half of the coronal tooth structure remaining have a reduced chance of long-term service, and patients should be so advised as the treatment plan is developed.
Fiber post is a method of restoring heavily destroyed teeth that are undergoing root canal treatment. Sometimes, if dental decay is not treated early, it advances to a level where most of the tooth structure is destroyed. The remaining tooth structure is so tiny that it cannot be restored by normal therapeutic methods. In such cases, fiber post: a thin cylindrical fixture is used.
Fiber posts are inserted inside the tooth&#;s root canal. First, your dentist at Southern Delaware Dental Specialists will open the tooth by removing the infected structure. Next, the tooth roots are emptied and cleaned. Once done, fiber posts, depending upon the number of roots, are placed inside the canal. The remaining root canal is filled with a root canal-filling material. The fiber post extends a little into the crown portion. This forms a foundation for the filling material. The lost structure is rebuilt around the fiber post.
Fiber posts provide a structure and help in rebuilding the lost tooth material. It strengthens the tooth after a root canal treatment and prevents further complications. It allows the tooth to function normally and saves it from being extracted. Fiber posts form an essential part of conservative treatments for heavily damaged teeth.
It is vital to remember that although we now have a wide variety of brilliant teeth replacement options, nothing can compare to our original teeth. Therefore, dentists will do their all to preserve and save your natural teeth, and fiber posts are one such method of doing so.
If you wish to save your pearly whites and have a glistening smile, then reach out to us today. Our team of excellent dental professionals is here to assist you and your family with excellent oral and overall health.
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