POST AND CORE RESTORATION OF ENDODONTICALLY TREATED TOOTH 1. POST 2. PIN 3. CORE 4.

FINAL PROTECTING RESTORATION WHY SHOULD A POST BE USED? 1. To retain restoration 2. To protect remaining tooth structure - force distribution rigidity for core Weakened RC treated tooth, why? a. caries b. prior restoration c. access preparation d. canal instrumentation e. dehydration WHEN SHOULD A POST NOT BE USED? 1. When retention of core is not necessary. 2. When protection of the remaining structure is not necessary Anterior teeth with sound structure ; need only resin or amalgam filling WHEN SHOULD A POST CAN NOT BE USED? 1. Traumatically injured tooth 2. Malformed tooth 3. Severe curvatured root 4. Need for further retreatment WHICH ROOT BE CHOSEN FOR POST INSTALLATION IN MULTIROOT TEETH? 1. Longest, straighted, greatest circumferential diameter 2. Which root reduce the possibility of lateral or apical perforation? Which root better distributes the stress due to occlusal loading? ---- Distal root of mandibular molar, Palatal root of maxillary molar 3. In situation of mesial (Mn.), Buccal (Mx.) --- use short post 4. Area of the root where the greastest amount of coronal tooth structure has been lost ---- adding a pin is better WHAT TYPES OF POST EXISTS ? A. 1. custom post 2. prefabricated post B. 1. screw post 2. cemented post

PREFABRICATED POST SYSTEM A. Threaded metal posts 1. Obturation screws (F.KG.) 2. Dentatus screw posts 3. Radix-Anchors 4. Kurer posts B. Unthreaded metal posts 1. Endo-posts 2. Charton crown post kits C. Pastic patterns 1. Endowels 2. Norm Plastic-Pins 3. Standard Plastic-Pins D. Combination kits 1. C-I kits 2. PD posts 3. Colorama 4. Para-post (Whaledent) WHAT SHOULD POST SPACE BE PREPARED? At RC filling appointment ; use hot instrument - no deterious effect to apical seal do not use rotary instrument -- loss of apical seal HOW IS POST SPACE PREPARED? A. Hot instrument B. Gate Glidden Drills and Peeso Reamer WHAT SHOULD DETERMINE THE DEMENSION OF THE POST CHANNEL? A. Post Depth 2/3 of root length equal or exceed the length of clinical crown leave 3-4 mm of GP in the apical B. Post width depends on root width and morphology no greater than 1/3 of the root width in its narrowest dimension WHAT ARE IMPORTANT CONSIDERATION DURING POST CEMENTATION 1. tapered post is selfs-venting 2. parallel post should be vented if not, hydraulic pressure root fracture or incomplete seating 3. remove the excess cement of post-tooth junction PREPARATION FOR POST CHANNEL Instruments a. Gates Glidden Drill for guid along the GP filling - non-cutting tip shorter cutting flutes (1.5-4.0mm) easy to bend - use only into 2-3 mm size 1 to 6 ( diameter 0.5 - 1.5mm, 0.2mm greater) length -- 18mm
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b. Peeso Reamer cut dentin latelly well, but do not cut dentin apically ( long cutting flutes - 7.5-8.5mm ) should be used in sequential order should always be rotating before it comes in contact remove from the canal while it is rotating size 1 to 6 ( diameter 0.7 - 1.7mm, 0.2mm greater ) c. Drill from the Selected Post Kits after using Gates Glidden and Peeso Reamer

*** CAST POST ***

DESIGN OF CAST POST PREPARATION 1. Proper Length of Post Channel - parallel side wall - round end surface 2. Flat Vertical Planes for Occlusal Stop 3. External Bevel - to provide finishing line - to avoid wedging force ( ferrule effect ) 4. Key Hole or Clover Form for Anti-rotation ; 1-2 holes 5. Internal Bevel for Counter-sink MARGIN OF POST PORTION 1) final margin on post - deep margin - advantage; impression for final restoration is easier 2) final margin on tooth structure - cover the post with metel framework of final restoration ONE PIECE VS TWO PIECE CROWN 1) ONE PIECE advantage; simple, cheaper retention, strength - good indications ; short crown close lingual clearance - very small space between U/L teeth 2) TWO PIECE advantage; path of insertion problem in multiple abutments casting accuracy in post portion - easy check of fitness of margin - can eliminate interference easily , more complete cementation - make triangular venting groove with inverted cone bur to prepare rework PREPARATION 1. proper instrumentation - retraction motion 2. orientation to the long axis of the root - step back endodontic canal preparation 3. adequate length of the preparation 4. proper internal shaping of the canal - slightly enlarging and modifying the existing anatomy
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- preparation of the orifice for antirotation, retention 5. proper outer surface shaping IMPERSSION A. INDIRECT TECHNIQUE lubricate the post canal prepare internal core for impression material - wire, wood, plastic, file etc. - cut to proper length - make retentive form for impression material injection into channel with regular type Rubber Base impression material insert the prepared core material over impression with regular type Rubber Base impression material careful removal of impression B. DIRECT TECHNIQUE lubricate the channel use thick file as core and handle material - Durallay Resin Sticky Wax Inlay wax, Sprue wax direct impression for post portion with up and down motion carving core portion intra-orally file handle cut off when make casting indication - undercuts in post preparation for fast, accurate casting for DDS designed retentive core *** AMALGAM POST *** : When remaining sound tooth material is good, well supported : main canal preparation -- 4mm small canal preparation -- 2mm depth and then only amalgam packing into post channel & core portion POSTERIOR TWO PIECE CAST POST SYSTEM : MAKE POST INTO TWO PIECE DUE TO NON-PARALLEL ROOTS Make one piece of main post and post and core with hole for second small post CORES Material 1. metal -- casted, amalgam 2. resin -- Core Max 3. Glass Ionomer + amalgam powder -- Miracle Mix 4. Glass Ionomer Silver -- KETAC SILVER 1. - good 2.- favorable in proper case 3.4.- no good

MARGIN AND CORE MATERIALS METAL -- METAL MARGIN OR RETORATION MARGIN any case is OK RESIN AND GI --cover at least 2mm with final restoration MATRIX FOR CORE Compound Supported Tofflemire Band
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Automatrix (retainerless) Copper Band Matrix Prefabricated Acrylic Resin Crown PULPLESS TOOTH AS A ABUTMENT Failure Rate of 1273 RC treated teeth ( in University of Califonia ) general ; crown (5.2%) < no crown (24.2%) in crown ; no post (3.3%) < post (8.2%) in no crown ; post (12.5%) < no post (24.6%) as prosthetic type Crown(5.2%) < FPD (10.2%) < RPD (22.6%) as post type Tapered cast dowel & core ( 12-16%) Cast Para-Post, Para-post & amalgam or composite resin (0%) GUIDELINES FOR POST IN ABUTMENT TOOTH 1. Single Crown ( less force ) - no dowel post just amalgam coronal-radicular core is good 2. Bridge -- stress increase as span increase -- for anterior short bridge ; post or no-post , any case is OK -- long span, posterior bridge ; need dowel post 3. RPD -- high stress, high torque, especially in distal abutment -- should prepare the dowel post 4. Pulpless posterior tooth -- protection by crown necessaryily 5. Post type tapered -- no good screw type -- no good due to high internal stress, high risk of root Fx. parallel, rounded end, small diameter -- good anti-rotation -- lock form, pin use of prefabricated screw type post -- select proper length and size and adjust, cementation