Definition Dowel: a post, usually made of metal that is fitted into a prepared root canal of a tooth that has

had endodontic therapy Core: the coronal aspect of the post foundation Restorative Challenge 1. Insufficient sound coronal tooth structure due to: Caries Endodontic treatment revious restorations !. Conse"uences of insufficient coronal tooth structure Retention of su#se"uent restorations are more pro#lematic Increases li$elihood of fracture during functional loading Restoring the Endodontically %reated %ooth: ost and Core Design and &aterial Choice of Restorative %echni"ue 'actors %ype of %ooth ( )nterior *.+. osterior, ) m o u n t o f R e m a i n i n g C o r o n a l t ooth structure %opics of Discussion Diagnosis and %reatment lanning Considerations and -uidelines for )nterior %eeth Considerations and -uidelines for osterior %eeth

 reparation: . Root Canal . Coronal %issue Classification of refa#ricated osts Dowel/ ost &aterials Core &aterials )malgam Coronal ost0Core Indications for Custom Cast ost and Cores Custom ost Core Direct %echni"ue Custom ost Core Indirect %echni"ues rovisionali1ation Investing and Casting %ry0In Cementation Root erforations Common Causes of 'ailures Diagnosis and %reatment lanning rognosis of tooth Endodontic Considerations 1. -ood apical seal !. 2o sensitivity to pressure 3. 2o e4udate 5. 2o fistula 6. 2o apical sensitivity 7. 2o active inflammation 8. Retreatment should occur if there are signs or symptoms indicating failure eriodontal Considerations 1. 9ltimate prognosis for a given tooth depends on periodontal status !. % r e a t m e n t o f p e r i o d o n t a l d i s easeis paramount prior to placement of definitive

restoration 3. E4tensive coronal destruction may re"uire Crown :engthening: a. Re0esta#lish #iologic width #. rovidecoronaltoothstruct ureto incorporate ferrule into cast restoration. rosthetic Considerations 1. E4tent of coronal destruction !. ;ther factors to evaluate a. %ooth type (anterior vs. posterior, #. osition in arch d. ;cclusal and prosthetic forces applied to tooth e. eriodontal support structure at the CE< 7. ;cclusal forces . )nterior teeth, forces are directed more laterally . osterior teeth, forces are directed more a4ially . 'or teeth acting as a#utments for ' D/ R D, there is an increase in occlusal forces Considerations for )nterior %eeth 1. Intact &arginal Ridges 0 lace #ase over - material and seal lingual access with an acid etch composite resin !. Discoloration in a#sence of significant tooth loss=>leaching 3. resence of mesial and distal restorations= post and core prior to placement of a crown

5. E4tensive loss of tooth structure 0 complete crown coverage is mandatory 6. % o o t h w i l l # e s e r v i n g a s ' D / R D a#utment 0 complete crown is mandatory Considerations for osterior %eeth 1. +u#?ected to greater loading than anterior teeth !. &orphology=cusps that can #e wedged apart0 increases suscepti#ility to fracture 3. Cuspal coverage to prevent #iting forces from wedging cusps apart E4ception : &andi#ular premolars and first molars with intact marginal ridges and conservative access cavities 5. Complete coverage especially for ma4illary premolars which have high fracture rate 6. Restorative &aterial include: a. &etal0ceramic restoration #. +ignificant coronal tooth loss: Cast post and core or an amalgam foundation restoration rin ciple s of %o o t h r e p a r a tio n : Conservation of %ooth +tructure reparation of the Canal 1. R9:E : Remove only the minimal tooth structure !. E4cessive enlargement results in: a. erforation or wea$ening of root #. +plitting during cementation of post or in function

3. &a$e post fit into the tooth and not the tooth fit into the post@ reparation of Coronal %issue 1. Conserve as much of tooth structure as possi#le !. )mount of remaining tooth structure is pro#a#ly the single most important predictor of clinical success 3. &ore than !mm = post design plays little role in the fracture resistance of the restored tooth 5. :ess than !mm = crown lengthening is indicated %he 'errule Effect Definition: 1. 'er0rule/Afer0el/ n: a circumferential #and of metal that engages the cervical tooth structure as part of the post and core preparation !. Cervical 'errule helps encompass tooth structure and prevent fracture Dowel: a post, usually made of metal that is fitted into a prepared root canal of a tooth that has had endodontic therapy Core: the coronal aspect of the post foundation 3. Increases retention 5. Increase resistance to root fracture 6. Resist lateral forces 7. Reinforces tooth at its e4ternal surface 8. Belps dissipate occlusal forces

C. :ac$ of sufficient ferrule forces the post and core to accept high functional forces Creating a 'errule E4tension of the a4ial wall of the crown apical to the missing tooth structure #y: +urgical Crown :engthening DReduces root length DIncrease crown length D:ess favora#le crown0to0root ratio DIncreased leverage on root during function ;rthodontic E4trusion DReduces root length DCrown length remains unchanged D&ore favora#le crown0to0root ratio D&a y # e p r e f e r r e d t o s u r g i c a l c r o wn lengthening D+tainless +teel D%itanium D%itanium )lloy D-old0 lated #rass DCar#on DCeramic Core &aterials D)malgam DComposite D-lass Ionomer )malgam E Composite E -lass Ionomer rocedure 1. Removal of the root canal filling material to the appropriate depth (Removal of -utta0 ercha,

%wo common methods: DFarmed endodontic plugger = prefered #ecause it eliminates the possi#ility of damaging the dentin DRotary Instruments ( esso0Reamers and -ates -lidden drills, = used if - is old and has lost itAs thermoplasticity a. Calculate appropriate :ength of ost -uidelines: D ost :ength G height of anatomic crown or !/3 the length of root D:eave 6mm of apical gutta0percha DB o w e v e r i n s h o r t t e e t h a n a # s o l ute minimum of 3mm #ut not less is accepta#le #. )pply Ru##er Dam c. +elect endodontic plugger that is large enough to hold heat well #ut not too large that it #inds against the canal walls d. &ar$ it at the appropriate length G (F:0 6mm, and place into canal to soften the gutta0percha -uidelines for using Rotary Instruments: DChoose an instrument that is slightly narrower than canal D'ollow - and do 2;% engage dentin D;nly remove part of the - with instrument andremainderremovewithhea ted condenser D2>: Rotary instruments are not to #e used immediately after o#turation #ecause it may distur# apical seal

!. Enlargement of the canal D+hape Canal as needed using low0speed drill or hand instruments . Removes undercuts . repares canal to receive an appropriate si1ed post D%a$e a radiograph to verify post space D>e careful not to remove more dentin at the apical e4tent of the post space than is necessary 3. r e p a r a t i o n o f t h e c o r o n a l t o o th structure DC o r o n a l t o o t h s t r u c t u r e r e d u c edfor e4tracoronal restoration DIgnore any missing tooth structure and prepare remaining tooth structure D>e sure that the facial surface of the tooth is ade"uately reduced for good esthetics DRemove all undercuts that would prevent withdrawal of the pattern DRemove any unsupported tooth structure #ut careful to preserve as much of the crown as possi#le D>e sure part of the crown is prepared perpendicular to post (shoulder, to allow seating DEliminate sharp angles and esta#lish smooth finish line

ost +election:an Introduction D refa#ricated osts . reformed metal post cemented into prepared post space .Core material DCustom0made osts . ost and Core are cast as single unit -uidelines in ost +election: DRule of %hum#: ost should #e no more than 1/3 the diameter of the root, with the root and walls at least 1mm thic$. D;ther 'actors: Hnowledge ofI . )verage root dimensions . Root canal cross0section configurations ost +election: 'actors to Consider D o s t + i 1 e : I n c r e a s e o s t D i ame t erJ Decrease Dentin %hic$ness J Increase +tress on %ooth J I2CRE)+E ')I:9RE D2um#er of osts : . 'or &ulti0rooted teeth at least 10! posts . &a4 &olars =usually palatal canal . Increase num#er of posts J Increase retention J Decrease tooth strength D ost :ength: . Increase in ost :ength J Increase chancesof erforationJIncrea se ')I:9RE (Compromise apical seal, . Decrease post length J Increase ris$ of root fracture D ost surface te4ture :

. +errated post more retentive than smooth post . 2 > : o s t l e n g t h i s mo s t imp o r t a nt retentive factor and ost Diameter is a secondary factor 'or &ulti0rooted teeth at least 10! posts0 &a4 &olars= usually palatal canal refa#ricated osts Classification 1. %apered ost a. ). 2on0%hreaded/+mooth #. >. +errated c. C. %hreaded !. arallel0+ided osts a. D. 2on0%hreaded/+mooth #. E. +errated c. '. %hreaded %apered ost )dvantages of %apered osts Conservative of tooth structure Bigh strength and stiffness Disadvantages of %apered osts :ow retention :ongitudinal splitting of remaining root (Hantor &H, ines &+, < D 3C:5K6.1L88, Recommended 9se of %apered osts: +mall circular canals or *ery tapered canals recautions of %apered osts 2ot recommended for e4cessively flared canals

refa#ricated ost: arallel0 +ided osts, 2on0%hreaded/+mooth )dvantages: E4cellent clinical retention &inimal stress production within root Ease of placement +uperior rating Disadvantages: recious material post e4pensive Corrosion of stainless0steel :ess conservative of tooth structure Recommended 9se: +mall circular canals recaution: Care during preparation refa#ricated post: %hreaded osts )dvantages: Bigh retention Disadvantages: Decrease post length, Increase ris$ of root fracture +tresses generated in canal may lead to fracture 2ot conservative of coronal and radicular tooth structure Recommended 9se: ;nly when ma4imum retention is essential recaution: Care to avoid fracture during seating refa#ricated osts: Car#on 'i#er posts )dvantages:

Dentin #onding Easy removal Disadvantages: :ow strength &icrolea$age Car#on color presents an esthetic pro#lem Recommended 9se: &inimal missing tooth structure 9ncertain endodontic prognosis of tooth recautions: 2ot recommended for teeth under lateral load refa#ricated ost: Mirconia Ceramic osts )dvantages: Esthetics Bigh stiffness Recommended 9se: Bigh esthetic demands Custom Cast ost and Core )dvantages: reservation of ma4imum tooth structure, Bigh strength Disadvantages: %ime consuming, comple4 procedure Recommended use: Elliptical canals 'lared canals ost +election: %he Dilemma Fhen should a custom cast post and core #e made vs. a prefa#ricated post and coreN Fhen there is e4tensive loss of tooth

structure Fhen there will #e heavy occlusal forces applied to the final restoration If the tooth will act as an a#utment to a ' D or R D Custom Cast ost and Core Can #e cast from : Direct %echni"ue 'a#ricated in patientAs mouth Indirect %echni"ue 'a#ricated in dental la#oratory 'or multiple canals Custom &ade ost: Direct %echni"ue Custom &ade osts: Direct %echni"ue (0pretend the model is patient's mouth0, D:ightly lu#ricate canal and ma$e sure plastic dowelOspeedy postPe4tends to full depth of post space D9se the #ead #rush techni"ue and add -C resin to canal space, the addOspeedy postP inside the canal and seat completely DDo 2;% allow resin to set completely. :oosen and reset it several times while it is still ru##ery D;nce resin has polymeri1ed, remove the pattern DInspect for any undercuts in pattern and trim away D&easure and verify pattern post is same as prepared post length DChec$ that pattern goes in and out of canal without #inding D)dditional resin is added for the core

Custom &ade osts : Indirect %echni"ue )nyelastomericmaterialwillm a$e anaccurate impression of the root canal if a wire reinforcement is placed to prevent distortion DCut ortho wire to length and shape of letter < ('igure ), D*erify the fit of the wire in the canal (should fit loosely and e4tend to full depth of post space, DCoat the segment with tray adhesive D:u#ricate canal to facilitate removal of refa#ricated osts Classification %apered ost ). 2on0%hreaded/+mooth >. +errated C. %hreaded arallel0+ided osts D. 2on0%hreaded/+mooth E. +errated '. %hreaded impression material and place retraction cord if su#gingival margins D, fill canals with elastomeric impression material D+eat the wire reinforcement to the full depth of each prepared teeth and insert the impression tray DRemove the impression and evaluate it ('igure C, D our the wor$ing cast (figure D, DRoughen a loose fitting plastic post D&a$e sure it e4tends to depth of the canal

D)pply a thin coat of stic$y wa4 to the plastic post and add soft inlay wa4 in increments DFa4 the core 'ig.C Core 'a#rication DC o r e o f t h e p o s t 0 a n d 0 c o r e r e s t oration replaces carious, fractured or missing tooth structure DIt also retains the final crown D&aterial used: )malgam, Composite, -lass 'ig.C Custom &ade ost: Direct %echni"ue Core >uild 9p with Composite resin and prefa#ricated post 'ig.L Composite Resin Core )dvantages: D-ood compressive strength DEasy to manipulate DRapid polymeri1ation DDentin #onding Disadvantages: D olymeri1ation shrin$age Recommended 9se D%e e t h wi t h mi n imum t o o t h s t r u c t ure missing -lass Ionomer Resin )dvantages: D)nticariogenicN D)dhesive

DEasy to manipulate Disadvantages: D:ow resistance to fracture D:ow retention to preformed post D+ensitive to moisture Recommended 9se: D%eeth with minimum tooth structure recaution D2ot for use in teeth under lateral load &ost common types of post0core failure D ost loosening D)pical lesion and caries D ost dislodgment a# cd D%ooth fractures DRoot perforation Bow to )void Root erforation D ost should not e4tend more than 8mm apical to the canal orifice in a molar D eeso Rotary instruments should #e avoided D DRecommended: Beated instruments and -#urs

Decrease post

'ig.C

Custom &ade ost: Direct %echni"ue

'ig.L

Custom &ade osts: Indirect