Post-endodontic rehabilitation using glass fiber non metallic posts: A review
Generally endodontically treated teeth have already undergone significant coronal destruction, loss of radicular dentin and an overall reduction in the capability of the tooth to resist intra-oral forces. The high success rates in modern day endodontics has resulted in an increased demand for an aesthetically convenient post and core system to help restore loss tooth structure. While the metallic post and cores provide a time-tested fulfillment of replacing the missing coronal tooth structure sufficiently to provide the required retention and resistance for the final restoration, yet aesthetic compatibility with the tooth structure is often compromised. Another important issue that is often not taken into consideration while using metallic posts is retreivability, when a metallic post fractures or fails, it is often virtually impossible to remove the residual post from the radicular portion of the tooth without greatly compromising the remaining dentin. Recent development in the field of esthetically viable non-metallic endodontic posts has served to erase these predicaments by providing an esthetically pleasing, easily retrievable post and core anchorage to replace the missing coronal tooth structure. This paper highlights the objectives, advantages and clinical predi- ctabilities in using a luscent glass fiber non-metallic post , thus providing an endo-aesthetic restorative continuum for both the patient and the dentist. Key words: Post and core restoration, glass fiber nonmetallic post, endo-esthetic restorative monobloc, enhanced bond strength
The prosthetic treatment of seriously damaged, endodonti- v. Woven polytage fiber post cally treated teeth often requires an endodontic post as an vi. Silicate glass ceramic posts additional retention element for core build-up prior to Various three point bending tests and cyclic fatigue crown restoration. Teeth that have been endodontically measurement studies have found carbon and glass fiber treated often have little coronal tooth tissue remaining and post systems to have comparable strength and fatigue 4 require a post that have been cast or machined from metal values as of titanium metal posts. Glass fiber posts are 1 to retain the core and restoration. Generally, such endodo- being much advocated by clinicians due to their ease of ntically treated teeth have already undergone significant use, adequate strength, easy retreivability and esthetic coronal destruction, loss of radicular dentin and an overall biocompatibility to form a composite monobloc. reduction in the capability of the tooth to resist a myriad of 2 Clinical considerations of glass fiber postsintraoral forces. The non-metallic posts serve to bring the The methodology of use of a glass fiber post can be clearly concept of an ideal post and core system, nearer to reality understood if we follow the following protocol.by giving an endoesthetic restorative continuum comprisI. A successfully root canal treated tooth, in need of post-ing of an esthetic post, a composite resin core and a resin 3 endodontic rehabilitation, is evaluated radiographica- luting cement. This monoblock ensures not only high lly, to confirm adequate apical seal.quality esthetics but is also safe, durable and easy to use by II. The gutta percha is adequately removed keeping a 3-4 the clinician. mm intact apical seal of gutta-percha.The following article tends to present to the avid clinician, III. The glass fiber post is inserted and tried after adequate the ease in using a glass fiber reinforced non-metallic post canal preparation.along with addressing the advantages and clinical conside- IV. The selected glass fiber post is luted in place with a rations to be kept in mind while achieving an esthetic dual cure composite resin luting cement.homogenous post-endodontic restoration. V. The composite core is build up and impression is taken for an all- ceramic crown restorationTypes of non-metallic posts The main function of the post is to anchor the post-and-core The basic application of a non-metallic post in the postcomplex within the radicular portion of the remaining endodontic restorative phase of a tooth is based on the 5 tooth. A post that can be bonded to tooth structure impro-usage of the correct post in a given situation. We can gener- ves its ability to retain the entire foundation. Therefore, it is ally divide all available non-metallic posts based on their important to select a post system that provides maximum composition into the following six types: retention, yet removes as little as possible of the remaining I. Glass fiber posts 6ii. Zirconium oxide posts subgingival tooth structure. iii. Ceramic posts The Luscent anchor post (Dentatus) is a fiber-glass, clear
1 2 Professor,Department of Prosthodontics, Seema Dental College and Hospital, Rishikesh, Professor, Department of Conservative Dentistry and Endodontics, IDST, Modinagar, India. Correspondence: Dr. Meenu Jain, email:email@example.com
Indian J Stomatol 2011;2(2):117-119
resin post that is designed to refract and transmit natural Placement of long posts into short roots may result in the tooth colors for esthetic post-and-core foundations. It is disruption of apical root canal seal. usually placed passively in prepared canals, it is available A lower fracture resistance was reported among roots of in three diameters and is size integrated with the light periodontally compromised teeth reconstructed with posts 11transmitting posts (Table 1). The composite core has exceland core. Naumann et al., concluded that the reduction of lent adaptation to the remaining tooth structure. The comp- the level of bone support would reduce the fracture resis- osite core forms strong bonds to remaining tooth struct- tance of fiber posts restored teeth. Alveolar bone level is ures, bondable posts, resin cements and ultimately, the considered a critical factor for stress concentration and 7final restoration, creating a monobloc. tooth fracture. Finite element studies reported massive Advantages offered by the non-metallic glass fiber post increase in dentinal stresses as the alveolar bone level was 11over the conventional metallic post include enhanced bond diminished. The loss of alveolar support will lower the strength, formation of a cohesive and strong foundation level of the mechanical fulcrum, which in turn will jeopa- 12with light or dual cure composite resin and easy retrieval rdize the fracture resistance of post restored teeth. In order also. The concept of intraradicular rehabilitation that often to obtain adequate fracture resistance, at least 1:1 crownto plays a key role in the final durability of the restored tooth root ratio should be ensured and the post should extend 7 is achieved with non-metallic posts. beyond the level of alveolar bone . Surgical crown length- An additional advantage of the non-metallic post is its ening can reduce the crown to root ratio and predispose favourable esthetics in anterior teeth when restored with all tooth fracture. Gegauffreported significantly lower failure ceramic crowns due to their light transmitting capacity in loads of teeth that had crown lengthening even with the 12addition to their modulus of elasticity values that are presence of a ferrule. similar to that of dentine and this can reduce the risk of One of the most important considerations in the use of nonfractures and in turn can increase their survival compared metallic posts is retrieval. When a metal post fractures or 8,9to teeth restored with metallic posts. otherwise fails, it is virtually impossible to remove the Trial, before cementing a post in place, is a must, to see the residual post from the radicular structure of the tooth 10proper placement, position and length of post in dentin. without greatly compromising the remaining dentin. Resin 13After placement of the post and before curing initiation, the fiber posts are retrievable easily. The use of a Gates excess flashes of composite should be removed by micro- Glidden drill through the existing post can rapidly and brush to aid in better post placement. Curing of composite safely access the underlying guttapercha root canal filling. at minimum of 40 seconds is advocated, but this variable Post retrieval is thus rapid, routine and predictable. depends on the type of composite cement used and the Occasionally, the post endodontic preparation of the canal manufacturer's instructions. Core build up, is accomplis- may be too wide for routine direct restoration, due to exten- hed in the same sitting. Shade matching should be accomp- sive decay or aggressive instrumentation of the canal. In lished keeping the variables of Hue, Chroma and Value in such cases, simply placing a post in the canal would leave a mind, so that the core composite material is of the same very thick layer of cement and also it may be difficult to shade, as the all ceramic crown for an esthetic result. position the post in an ideal location. In such cases, nonmetallic post-systems like the Luminex light transmitting Discussion system (Dentatus, NY) may be used to rehabilitate the Preliminary analysis of periapical radiographs is canal by inserting the post to desired length, using a resin compulsory in the restoration of endodontically treated cement that is injected into the canal and after curing, teeth. The root length, shape, amount of tooth structure pushing the light transmitting post out by rotating and lost, periodontal status, periapical radiolucency and removing with a haemostat, leaving an ideally shaped and quality of endodontic treatment, all contribute to the sized post space that can be treated routinely by using a size success or failure of the post endodontic restoration. matched luscent anchor post. Post placement should be as long as possible for stress Another important consideration in using non-metallic distribution and better retention along the dentin. posts is the use of non-adhesive cements for final luting.
Indian J Stomatol 2011;2(2):117-119
Luscent anchor post system
Fiber kor post system
Zirconium oxide ceramic post (cerapost) Zirconium oxide all ceramic Post(cosmo post) Silicate to glass ceramic fiber post
Jeneric Pentron CT, U.S.A
Brasseler Savannah, U.S.A. Brasseler Savannah, U.S.A. Glasspan, Eyton U.S.A.
Table 1: Types of metal free posts
Luting agents conventionally used in metallic posts
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Indian J Stomatol 2011;2(2):117-119