When to use a dental post and what kind of dental post to use

Dental post placement is much less common today than it was in the past due to our ability to bond to tooth structure. However, the dental post still has it’s place and are IMHO not in use as often as they should be.

Dental post placement step by step

1. Length about 1/2 way down root 
2. 17% EDTA 1 minute – 1 minute CHX
3. Alcohol clean and then silane on post
4. C-I white Parkell with ParaCore Coltene Whaledent (SE Cement and Core in one) OR ParaPost XP SS Coltene Whaledent=much stronger (CR Report)
5. True etch and rinse is better if fiber post (good comprehensive article)
6. DC resin cement

When to use a dental post?

Reading the conclusions of the lit review below will tell you when to use a dental post and what dental post may be best. There is no clear answer though. Clinican’s Research findings state one should use a post when the tooth has a root canal and has one of any of the following conditions.

• Less than 1/2 of tooth structure supra0ginval
• Canines and abutment teeth
• Grinders and bruxers
• Lone standing tooth

 Dental Post Studies

Lit review Schwartz JOE 2004 – Remember – The primary purpose of a post is to retain a core in a tooth with extensive loss of coronal tooth structure.  However, preparation of a post space adds a certain degree of risk to a restorative procedure. The placement of posts also may increase the chances of root  fracture and treatment failure, especially if an oversized post channel is prepared.  For these reasons, posts should only be used when other options are not available to retain a core. The need for a post varies greatly between the anterior and posterior teeth.

1. Anterior tooth with small restoration or veneer just composite build-up.
2. Anterior tooth with or getting a crown should have post
3. Molars only need 1 post if major destruction of coronal portion tooth, never 2 posts.
4. Premolars sometimes need posts
5. Composite post failures tend to be repairable vs metal post failures that tend to be terminal for tooth Lit Review Fokkinga
6. Metal posts do not strengthen root but bonded posts DO (for awhile anyway).
7. Ceramic and Zi posts can not be removed if need retreat.
8. Tapered posts in teeth with thin roots only (parallel almost always better)
9. Cast post and only for correctly angle of severely angled tooth or in very small lower incisor.
10. Metal posts seem to work slightly better than resin but check #5
11. Avoid active posts, Ti posts, ceramic, and Zi posts.
12. Overall recommendation is to use fiber posts

Lit review of fracture resisitance AL-Omiri – Adhesively luted resin/fiber posts with composite cores appear to be the best currently available option in terms of tooth fracture and biomechanical behaviour. Yet Sarkis-Onofre JOE 2017 finds metal posts better IF no ferrule.

Lit review Ferrule effect Juloski JOE 2012 – 1.5mm to 2mm

Lit Review Balevi 2015 EBD – Tooth fracture metal vs fiber unsure

Lit review from J Prosthetics 2003 opens with “Most endodontically treated teeth require a post-and-core build-up for restoring the teeth to optimum health and function.”  I struck the stupid stuff

1. custom-cast post and cores are recommended for noncircular root canals and when coronal tooth structure loss is moderate to severe
2. posts with an antirotational feature should be used in situations with circular canals
3. passive parallel posts are advocated for adequate retention but when the apical thickness of dentin is minimal, a parallel-tapered combination post design may be preferred
4. retentive qualities of the post head may facilitate firm retention of core material
5. retrievability in the event of failure should be considered

Cast post higher fracture resistance than fiber  Meta-analysis (so maybe in heavy grinder with minimal coronal tooth structure cast better)

Overall metal and fiber about = in fracture resistance but cast metal and glass fiber are better than prefab metal and carbon fiber Meta-analysis Figueiredo JOE 2015

Non systemic review or meta-analysis studies

Composite vs. Fiber post oct 11 = fiber post better

Oval posts in oval canals better adapted than round?  NO

Effects of post, core, crown type, and ferrule Nov 10 – Fiber posts best anterior and use cast post and core with metal crown.

Cast metal core vs. resin luted core – Resin core better (not sure how this impacts posts per se)

Metal posts vs. fiber post in anterior teeth (lab only) Feb 11 – Metal better especially under ceramic crown This is consistent with other findings in that metal is less likely to fail but if does more permanent failure ie tooth fracture versus post coming debonded with resin.

Metal post seals anteriors better Sept 12although may be true check #5 in 1st lit review.  So resin may leak more but metal will have catastrophic failure

Glass fiber=Ti with self-adhesive luting prefab