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Fayez Faraj Mohammed Al Khaldi, 2020;4(2):534–537.

International Journal of Medicine in Developing Countries

Post placement and restoration of endodontically treated teeth: a review

Fayez Faraj Mohammed Al Khaldi1*

Correspondence to: Fayez Faraj Mohammed Al Khaldi

*Resident, Dammam Medical Complex, Dammam, Saudi Arabia.

Email: alkfayez [at] gmail.com

Full list of author information is available at the end of the article.

Received: 23 December 2019 | Accepted: 03 January 2020


ABSTRACT

After complete endodontic filling of the root canals of the devitalized tooth, teeth restoration is very important for maintaining the remaining tooth structure and prevention of tooth fracture. In some endodontic teeth, the use of intracanal posts is important for teeth buildup and retention of the core material. Nowadays, there is a variety in the types of posts and the materials from which the dentist selects the suitable one for each case. This study aims to review the major related researches on this topic with an emphasis on major decision-making elements in post placement and restoration of endodontically treated teeth. A MEDLINE search was completed for the time period from 1990 to 2019 along with a manual search, to locate relevant peer-reviewed articles and textbooks published in English. Several keywords were used to obtain all possible articles concerned with the subject. We have found 25 articles on our search, and only 21 articles were specifically related to our subject. The study concludes that few studies have focused on the restoration of endodontically treated teeth and post placement, and also, there were no previous review articles studied this subject.


Keywords:

Posts, endodontic treated, restoration.


Introduction

Endodontic treatment is a precise operation that requires special precautions for teeth preservation and the prevention of endodontic failure [1]. Endodontic treatment is fairly predictable in nature with reported success rates up to 86%–98% [2]. Before endodontic treatment, the teeth should be diagnosed properly clinically and radiographically to determine the prognosis of the teeth after endodontic treatment [3]. After endodontic treatment, preservation of the tooth through various types of restoration and full coverage with the crown is important [4]. Many researchers have concluded that dentine of the endodontically treated tooth is more brittle than the dentine of vital teeth due to several causes such as dehydration of the dentine resulting from loss of water, loss of collagen cross-linking, and changes in crown-to-root ratio [4]. However, in the posterior teeth, which are different in fracture resistance according to lost structure, class 1 restoration reduces the tooth stiffness by 20% and complex class II restoration reduces the stiffness by 63%. In some conditions, where the endodontic teeth have lost one or more structure from the tooth walls, full-coverage restoration is not enough only for tooth preservation [5]. In these cases, post placement is important after endodontic treatment and before final restoration placement to build up the destructed walls [6]. Post designs and materials are variable in the market, from which the dentist selects the suitable type for the endodontic tooth [7]. Posts are made from various materials such as ceramic, metal-like (stainless steel, titanium, and gold), and fiber-reinforced posts [8]. There are two important rules that should exist in the selection of posts: first is the retention of the post to be able to resist the vertical forces and second is the post resistance to be able to resist the horizontal and rotational forces [9]. Post resistance is influenced by the existence of ferrule, anti-rotational features, length of the post, and finally its rigidity [9].


Principles of Restoration of Endodontic Teeth

Many studies have concluded that successful endodontic treatment has a high survival rate which lasts for several years [10]. In addition, endodontically treated teeth need full coronal and cuspal coverage for teeth protection against fracture and preservation of tooth integrity [11]. Furthermore, bonded restorations in the posterior teeth are short-limited restorations that cannot afford the heavy forces from occlusion. While in the anterior teeth with minimal loss of teeth structure, the composite resin is used as final restoration; otherwise, if the coronal structure is highly damaged with large loss of tooth structure, post placement and core buildup are needed, followed by full coronal coverage [12]. Many studies have concluded that endodontic tooth fracture is the main cause of endodontic failure, so coronal coverage should not be neglected to avoid tooth fracture [13]. In addition, the percentage of root fracture is high when metallic posts are used with amalgam core as compared to the use of fiber post with composite core [14].


Principles of Post Use, Application, and Space Preparation

Post application is highly important for building up a core material in situations of a large loss of tooth structure. In addition, the ferrule is important when a post is used with at least 1-mm thickness of dentine and 2-mm vertical height [15]. Post usage in the anterior teeth is more common as the pulp chamber is small which cannot retain the core itself. In addition, post usage in premolars is determined by the amount of lost tooth structure [16]. In molars, posts are rarely used due to large pulp chambers which can retain the core material without using post, but when large tooth structure is lost, post use is important and mainly inserted in distal canals of the lower molars and palatal canals of the upper molars [17]. In addition, multiple post application may be needed in situations when the coronal structure of the endodontic tooth is missing more than one wall [18]. For proper post application after endodontic treatment, the creation of space in the root canal for the post is needed [19]. First, root canal drill is selected with special size according to the canal width and with a low-speed contra-angle; the root canal is drilled carefully to avoid root canal perforation or vertical root fracture [20]. The root canal is prepared by removing the gutta-percha in the coronal two-thirds of the canal, and the apical one-third is left unprepared with a minimum of 4-mm height [21]. After that, the appropriate post is selected according to the size and length of the root canal. The metal post is inserted in the canal using a special post driver in the rotational movement until reaching the full prepared length of the canal and without the presence of a gap between the post and the gutta-percha [22].


Principles Indicated for Post Success

Ferrule effect

It is an important principle for post retention, resistance, and longevity. It is defined as a vertical band of the tooth structure at the gingival aspect of a crown preparation. It is considered as the most important principle for the long-term success of the post [5,7].

Retrievability

In patients, who had unsuccessful endodontic treatment followed by post application, post retrievability from the canal is important for endodontic retreatment. Metal and fiber posts can be easily removed from the canal, while zirconium and ceramic posts are very difficult to be removed from the canal [6].

Preservation of the tooth structure

Coronal and radicular tooth structure should be preserved as possible during space preparation for the post. Most of the types of posts need minimal dentine removal for post application, especially tapered posts, while parallel posts need more dentine removal [7,8].

Retention and resistance

Post retention is defined as the post resistance to vertical forces, while post resistance is defined as the post resistance to lateral and rotational forces. Post retention is related to many factors, such as the post length, diameter of the post, taper of the post, active or passive post, and luting cement used. Post resistance is influenced by the post length, remaining tooth structure, rigidity, and presence of ferrule [8,9].


Types of Posts

Posts are classified into different categories as follows:

Active or passive posts

Active posts are characterized by the presence of threads which when applied into the root canal can engage the walls of the canal and give the highest retentive effect, while passive posts are retained into the canal using luting cement [23]. Active posts give more retention than passive posts, but due to stress existing within active posts, they may lead to root fracture and this is not found in passive posts. Hence, the use of active posts is preferred to be limited to short roots, in which a maximum retention is needed [24].

Tapered or parallel posts

Parallel posts are more preferred than tapered posts due to many factors [25]: parallel posts are more retentive than tapered posts, stress existence is less with parallel posts than tapered posts, and as in parallel posts, there is a less wedging effect and so less liable to cause root fracture rather than tapered posts. On the other hand, tapered posts need least dentine removal from the canal as most of the canals are tapered so more preservation of the tooth structure [26].


The material of the post:

i-Metal posts

a—Prefabricated metal posts:

It is considered as the most used posts by the dentists due to its simplicity; it needs short time for application into the root canal, in which all preparation steps of the root canal for creating space for the post and post application and the final core material can be done in the same visit [27]. These types of posts can be fabricated from different types of metal alloys such as titanium and copper. Titanium posts are more preferred than other types due to its biocompatibility and high strength resisting the occluding forces and its decreased liability to fracture [28]. On the other hand, metal posts are difficult in removal from the canal if retreatment is needed, and also, it is difficult to be differentiated radiographically from the gutta-percha due to their same radiopacity [29].

b—Cast metal posts:

This type of post is highly successful and gives excellent results [30]. In addition, it has an advantage of simplicity in removal from the root canal if retreatment is needed [31]. On the other hand, it has some disadvantages that make its use difficult and limited like [32]; it is more expensive than prefabricated posts, many visits from the patient are needed because it needs to be sent to the laboratory, and contamination of the root canals may occur due to longer preparation time and multiple visits.

ii-Fiber posts

Fiber posts are considered as an excellent type of posts due to its excellent characteristics and simplicity. In addition, it has a modulus of elasticity similar to the modulus of elasticity of dentine that makes it perfect in stress force distribution and so decreases the occurrence of root fracture [33]. It contains either carbon fibers or quartz fibers that strengthen the root when used with the luting cement in the root canal. In retreatment cases, carbon fiber posts are easier in removal by ultrasonic drill than quartz fiber posts [34]. On the other hand, the high flexibility of the fiber post makes it liable to move under the occluding forces leading to leakage and contamination of the root canal [35].

3-Ceramic and zirconium posts:

This type of post is considered as the highest esthetic posts which are used in teeth where esthetic is highly required, especially, in the anterior teeth to avoid discoloration appearance [35]. On the other hand, these posts are very difficult in removal from the root canal in retreatment cases and its removal can be only with burs that make a risk of root perforation [36].


Conclusion

Endodontic restoration is a very important step after root canal treatment to preserve the remaining tooth structure and prevention of tooth fracture. Most of the endodontic teeth need full-coverage restoration after endodontic treatment, and others need first post placement for core buildup, especially, if there are destructed walls in the endodontic tooth than full-coverage restoration. There is a scarcity in studies on the post placement and restoration of endodontically treated teeth; also, most of them were trials and showed unclear results. It is recommended to establish more studies that focus on declaring the major decision-making elements in post placement and restoration of endodontically treated teeth.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Fayez Faraj Mohammed Al Khaldi1

  1. Resident, Dammam Medical Complex, Dammam, Saudi Arabia

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How to Cite this Article
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Fayez Faraj Mohammed Al Khaldi. Post placement and restoration of endodontically treated teeth: a review. IJMDC. 2020; 4(2): 534-537. doi:10.24911/IJMDC.51-1577134335


Web Style

Fayez Faraj Mohammed Al Khaldi. Post placement and restoration of endodontically treated teeth: a review. https://www.ijmdc.com/?mno=79147 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1577134335


AMA (American Medical Association) Style

Fayez Faraj Mohammed Al Khaldi. Post placement and restoration of endodontically treated teeth: a review. IJMDC. 2020; 4(2): 534-537. doi:10.24911/IJMDC.51-1577134335



Vancouver/ICMJE Style

Fayez Faraj Mohammed Al Khaldi. Post placement and restoration of endodontically treated teeth: a review. IJMDC. (2020), [cited October 15, 2021]; 4(2): 534-537. doi:10.24911/IJMDC.51-1577134335



Harvard Style

Fayez Faraj Mohammed Al Khaldi (2020) Post placement and restoration of endodontically treated teeth: a review. IJMDC, 4 (2), 534-537. doi:10.24911/IJMDC.51-1577134335



Turabian Style

Fayez Faraj Mohammed Al Khaldi. 2020. Post placement and restoration of endodontically treated teeth: a review. International Journal of Medicine in Developing Countries, 4 (2), 534-537. doi:10.24911/IJMDC.51-1577134335



Chicago Style

Fayez Faraj Mohammed Al Khaldi. "Post placement and restoration of endodontically treated teeth: a review." International Journal of Medicine in Developing Countries 4 (2020), 534-537. doi:10.24911/IJMDC.51-1577134335



MLA (The Modern Language Association) Style

Fayez Faraj Mohammed Al Khaldi. "Post placement and restoration of endodontically treated teeth: a review." International Journal of Medicine in Developing Countries 4.2 (2020), 534-537. Print. doi:10.24911/IJMDC.51-1577134335



APA (American Psychological Association) Style

Fayez Faraj Mohammed Al Khaldi (2020) Post placement and restoration of endodontically treated teeth: a review. International Journal of Medicine in Developing Countries, 4 (2), 534-537. doi:10.24911/IJMDC.51-1577134335