Post placement for restoring badly destructive teeth has been debated. While posts have been used since the 18th century, they are not always necessary when sufficient tooth structure remains. Posts are primarily used to retain cores for supporting final restorations. Factors like remaining tooth structure, post length, diameter and design influence stress distribution and fracture resistance. Fiber posts with proper elastic modulus and bonding ability have shown benefits over metallic posts in strengthening teeth when posts are indicated. However, an adequate ferrule is most important for preventing fractures. Further research is still needed to clearly define the optimal use of posts.

1. POST OR NOT TO POST ?
D R . H I C H A M N U A I M I
B D S . P G D I P I M P L A N T O L O G Y
P G D I P R E S T O R AT I V E D E N T I S T RY
M C L I N I N O P E R AT I V E A N D E S T H E T I C
D E N T I S T RY

2.  Treatment of Badly Destructive Teeth have huge
controversy about the decision of whether or not posts
should be used

3.  Restoring of badly destructive pulpless teeth have been
reported since 18 centurey.
 Pierre Fauchard in 1747 designed gold and silver
posts.
 Last decades fabricated Carbon posts due to its proper
elastic modules and flexture resisitance
 Due to upgrade in Esthetic demand, Scientist invest
cotted Carbon post then glass and ceramic ones.

4.  Role for post placement
 Indications
 Types
 Procedure

5.  The primary purpose for a post is to retain a core that
can be used to support the final restoration.
 Posts do not reinforce endodontically treated teeth,
and a post is not necessary when substantial tooth
structure is present after a tooth has been prepared.

6. Post placement is indicated if both of the following
clinical conditions exist:
 The remaining coronal tooth structure is
inadequate for the retention of a restoration.
 When there is sufficient root length to
accommodate the post while maintaining an
adequate apical seal.
Stockton L (1999).Factors affecting retention of post systems: A literature review. J
Prosthet Dent;81:380–385.

7.  Anterior teeth mostly required post, due to the
shearing forces and the narrow tooth
dimensions.
 While Large, bulky anterior teeth with minimal
access preparation may not require a post

8.  Molar teeth rarely require a post unless there
has been significant loss of tooth structure.
 Posts are generally considered necessary for
PM teeth because of their smaller diameter and
the presence of high shear stresses.

9. Types of
Post
Metallic
Stainless
Steel
Titanium
Gold-Plated
brass
Non
Metallic
Carbon
Fibre
Ceramic
Composite
Glass-fibre

10. Stainless
steel
Esthetic
carbon
fiber
Carbon
fiber
Ceramic

11. Tapered
smooth
Parallel
serrated
Parallel
threaded

12. Prefabricated
Threaded
Posts
Disdvantages
Stresses
generate may
lead to fracture
High invasive
Advantages
High retention

13. Carbon Fiber
Post
Advantages
Dentin
bonding
Easy removal
Disdvantages
Low strength
esthetic
problem
Lack of
radiopacity

14. Fiber
Reinforced
Post
Disdvantages
Low strength failure rate
Advantages
Esthetic

15. Zirconia
Ceramic
Disdvantages
High stiffness
High modulus
of elasticity
Advantages
Esthetic

16. Rodriques-Cervantes et.al (2007) stated that post
must have elastic modules mimic to that of
dentine or damage root structure
Tooth structure Elastic modules (Gpa)
Dentin 18.6
Fiber post 20
SS post 200
titanium 110
zirconia 300

17. Damage to the root
Shear
stress
internal
stress
zones
of
tension

19. Post
length
Post
design
FACTORS
Post
diameter
Stockton L (1999). Factors affecting retention of post systems: A literature review. J
Prosthet Dent;81:380–385.
Ferrule
effect

20.  The post should be > the IC or OC dimension of the
crown.
 The post should end halfway between the crestal
bone and the root apex.
 The post should be 2/3 the root length.

21. Ideal
Placement

22. ✔ ✖

23.  The diameter of the post is selected according
to root anatomy.
 A minimal dentin thickness of 1 mm around the
post should be provided.

24. Post preparation of the root
canal space must not
remove additional dentin
leads to reduced fracture
toughness

25. NARROW
MEDIU
M
LARGE

26.  Passive action posts lead
the lest stress in the root
dentine (parrallel,
smooth)
 Active action post lead
the highest stress
(threaded)

27. Active posts
Mechanical bend
into dentin by
threads
Passive posts
Depend on cement for
retention

29.  is the circumferential ring of
sound tooth structure that is
enveloped by the cervical
portion of the crown
restoration.
 A minimum sound dentine
height of 1.5 - 2 mm is
required between the core
and crown margins.

30. Fernandes et al.(2003) stated that ideal post
selection required:
 Minimum preparation.
 Resistance to fatigue.
 Elastic modulus similar to dentin.
 Retentive (post & Head).
 Easy to adjust and fit.
 Easy Removal
Fernandes A., Shetty Sh., Coutinho I.(2003). Factors determining post selection: A
literature Review. J Prosth. Dent. Dec. 2003.

32. Amount of remaining sound tooth structure
Occlusal function
Opposing dentition
Position of the tooth in the arch
Length, width and curvature of the roots
Endodontics : Restoring of Endodontically Treated Teeth American Association of
Endodontics.1995 Dec Publication

37. Ferrari et.al Fokkinga
SAMPLES
240 endodontically-treated
premolars in 210
patients
307 endodontically-treated teeth
in 257
patients
TEST
TREATMENT
Fiber posts for 2 years Cast post and core
Pre-fab metal post and
composite core for 17 years
CONTROL
TREATMENT
No post Post-free composite core
CONCLUSIONS
4 coronal wall remaining: no
difference in
complication rates
≤ 3 coronal walls remaining:
post placement
increases survival rates
Where “substantial remaining
dentin” is available, a post and
core does not perform better
than a post-free core

38. Ferrari M (2007). Post placement affects survival of endodontically treated
premolars. JDentRes;;86(8):729-734.

39. Fokkinga W.(2007). Up to 17-year controlled clinical study on post-and-cores
and covering crowns. J Dent;35(10):778-786.

40. Salemeh et.al (2007) stated that the fracture loads
of teeth restored with fiber posts were
significantly greater than those without posts.
The fiber posts significantly contributed to the
reinforcement and strengthening of pulpless
teeth.

41. D’Arcangelo et al. (2008) stated that fiber
reinforced post restoration with veneer
preparations (Max CI) did not show significant
differences from the intact unprepared incisor.
Hajizadeh et al. (2009) showed that PM teeth when
restored with the Post and composite were as
strong as the unprepared tooth and stronger than
those teeth restored with composite alone
without a post.

42. Jotkowitz et al. (2010) stated that the height,
number of walls remaining, thickness of the
walls in addition to ferrule effects on functional
stress. They concluded that no ferrule equals un-
restorable
Nam et.al (2010) stated that when the number of
remaining walls decrease, the fracture resistance
decreases, even without post. BUT the fracture
resistance is significantly increased when fiber
posts are placed.

44.  Using of natural teeth or bovine teeth
 Type and quality of the post
 Effect of “secondary smear layer” on adhesion
 Effect of type of radicular dentin that is to be
bonded
 Types the adhesive used
 Types of cement used for post placement
 The amount of critical dentin that is removed to
place the post.

45.  Badly destructive endodontic teeth are weaker,
so that it requires restorations to protect
remaining tooth structure.
 Ferrule effect is paramount to resist fracture and
is more important than post design, material or
luting cement.
 Clinical success depends on application of
sound biomechanical principles for the specific
tooth.
 More In vivo studies are required to distinguish
a clear evidence for using of fiber post

46. THANK YOU.