Direct or indirect post crowns to restore compromised teeth: a review of the literature

Key Points

  • Suggests there is no strong evidence to suggest either direct or indirect posts are more successful in most clinical situations.

  • Suggests that certain canal shapes may benefit from a cast post in order to achieve close fit of the post to the dentine structure.

  • Highlights that the condition of the remaining tooth structure is one of the most important factors in predicting the success of a post crown restored tooth.

Abstract

Post crowns are restorations which utilise the root canal space to improve the retention and resistance form of teeth which lack coronal tooth structure. In recent years there have been significant developments in the materials, systems and evidence-base surrounding the provision of post crowns. This review aims to refresh the general dental practitioner's (GDPs) knowledge of the different factors that must be considered when placing a post crown, and how these factors can help guide the dentist in their decision to provide either a direct or indirect post and core.

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Figure 1
Figure 2: a) Photograph showing a failed composite core and b) carbon fibre post in situ.
Figure 3: Radiographs and photographs of a threaded post being removed and replaced.
Figure 4: a) A long direct metal post in 22 with associated periapical radiolucency.
Figure 5: a) Radiograph showing a cast metal post, diverging slightly mesially from the canal.

References

  1. 1

    Huang YC, Lin CL, Ko EW Effects of proximal grooves and abutment height on the resistance of resin-cemented crowns in teeth with inadequate resistance: An in vitro study. Biomed J 2015; 38: 336–341.

    Article  Google Scholar 

  2. 2

    Gómez-Polo M, Llidó B, Rivero A, Del R ío J, Celemín A . A 10-year retrospective study of the survival rate of teeth restored with metal prefabricated posts versus cast metal posts and cores. J Dent 2010; 38: 916–920.

    Article  Google Scholar 

  3. 3

    Silva N R, Castro C G, Santos-Filho P C et al. Influence of different post design and composition on stress distribution in maxillary central incisor: Finite element analysis. Indian J Dent Res 2009; 20: 153–158.

    Article  Google Scholar 

  4. 4

    Figueiredo F E, Martins-Filho P R, Faria-E-Silva A L . Do metal post-retained restorations result in more root fractures than fiber post-retained restorations? A systematic review and meta-analysis. J Endod 2015; 41: 309–316.

    Article  Google Scholar 

  5. 5

    Piovesan E M, Demarco F F, Cenci M S, Pereira-Cenci T . Survival rates of endodontically treated teeth restored with fiber-reinforced custom posts and cores: a 97-month study. Int J Prosthodont 2007; 20: 633–639.

    PubMed  Google Scholar 

  6. 6

    Ferrari M, Cagidiaco M C, Goracci C et al. Long-term retrospective study of the clinical performance of fiber posts. Am J Dent 2007; 20: 287–291.

    PubMed  Google Scholar 

  7. 7

    Pontius O, Nathanson D, Giordano R, Schilder H, Hutter J W . Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement. J Endod 2002; 28: 710–715.

    Article  Google Scholar 

  8. 8

    Heydecke G, Butz F, Strub J R . Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. J Dent 2001; 29: 427–433.

    Article  Google Scholar 

  9. 9

    Coelho C S, Biffi J C, Silva G R, Abrahão A, Campos R E, Soares C J . Finite element analysis of weakened roots restored with composite resin and posts. Dent Mater J 2009; 28: 671–678.

    Article  Google Scholar 

  10. 10

    Peroz I, Blankenstein F, Lange K P, Naumann M . Restoring endodontically treated teeth with posts and cores-a review. Quintessence Int 2005; 36: 737–746.

    PubMed  Google Scholar 

  11. 11

    Schmitter M, Rammelsberg P, Gabbert O, Ohlmann B . Influence of clinical baseline findings on the survival of 2 post systems: a randomized clinical trial. Int J Prosthodont 2007; 20: 173–178.

    PubMed  Google Scholar 

  12. 12

    Farina A P, Cecchin D, Spazzin A O, Pires-de-Souza Fde C, Dartora N R, Mesquita M F . Evaluation of resistance to displacement of metal posts with different lengths. Indian J Dent Res 2012; 23: 613–616.

    Article  Google Scholar 

  13. 13

    Chuang S F, Yaman P, Herrero A, Dennison J B, Chang C H . Influence of post material and length on endodontically treated incisors: an in vitro and finite element study. J Prosthet Dent 2010; 104: 379–388.

    Article  Google Scholar 

  14. 14

    Jindal S, Jindal R, Gupta K, Mahajan S, Garg S . Comparative Evaluation of the Reinforcing Effect of Different Post Systems in the Restoration of Endodontically Treated Human Anterior Teeth at Two Different Lengths of Post Space Preparation – An in vitro study. J Dent (Tehran) 2013; 10: 124–133.

    Google Scholar 

  15. 15

    Cheung W . A review of the management of endodontically treated teeth. Post, core and the final restoration. J Am Dent Assoc 2005; 136: 611–619.

    Article  Google Scholar 

  16. 16

    Pappen A F, Bravo M, Gonzalez-Lopez S, Gonzalez-Rodriguez M P . An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space. J Prosthet Dent 2005; 94: 214–218.

    Article  Google Scholar 

  17. 17

    Rahimi S, Shahi S, Nezafati S, Reyhani M F, Shakouie S, Jalili L . In vitro comparison of three different lengths of remaining gutta-percha for establishment of apical seal after post-space preparation. J Oral Sci 2008; 50: 435–439.

    Article  Google Scholar 

  18. 18

    Tey K C, Lui J L . The effect of glass fiber-reinforced epoxy resin dowel diameter on the fracture resistance of endodontically treated teeth. J Prosthodont 2014; 23: 572–581.

    Article  Google Scholar 

  19. 19

    Kaur A, N M, N S, Kumari A, Shetty A . A comparative study of intra canal stress pattern in endodontically treated teeth with average sized canal diameter and reinforced wide canals with three different post systems using finite element analysis. J Conserv Dent 2010; 13: 28–33.

    Article  Google Scholar 

  20. 20

    Sahafi A, Peutzfeldt A, Asmussen E, Gotfredsen K . Retention and failure morphology of prefabricated posts. Int J Prosthodont 2004; 17: 307–312.

    PubMed  Google Scholar 

  21. 21

    Signore A, Benedicenti S, Kaitsas V, Barone M, Angiero F, Ravera G . Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage. J Dent 2009; 37: 115–121.

    Article  Google Scholar 

  22. 22

    Nergiz I, Schmage P, Platzer U, Ozcan M . Bond strengths of five tapered root posts regarding the post surface. J Oral Rehabil 2002; 29: 330–335.

    Article  Google Scholar 

  23. 23

    Hanson E C, Caputo A A . Cementing mediums and retentive characteristics of dowels. J Prosthet Dent 1974; 32: 551–557.

    Article  Google Scholar 

  24. 24

    Gaikwad A, Singh K P, Ranganath L M, Jain J K, Patil P, Babar G . Fracture resistance of teeth restored with various post designs and cemented with different cements: An in-vitro study. J Int Oral Health 2015; 7: 33–37.

    PubMed  PubMed Central  Google Scholar 

  25. 25

    Bolhuis HP, de Gee A J, Pallav P, Feilzer A J . Influence of fatigue loading on the performance of adhesive and nonadhesive luting cements for cast post-and-core buildups in maxillary premolars. Int J Prosthodont 2004; 17: 571–576.

    PubMed  Google Scholar 

  26. 26

    Liu C, Liu H, Zhu S . Effect of different irrigating solutions on bonding strength of fiber post to root canal. Hua Xi Kou Qiang Yi Xue Za Zhi 2011; 29: 210–213.

    PubMed  Google Scholar 

  27. 27

    Faria-e-Silva A L, Menezes Mde S, Silva F P, Reis G R, Moraes R R . Intra-radicular dentin treatments and retention of fiber posts with self-adhesive resin cements. Braz Oral Res 2013; 27: 14–19.

    Article  Google Scholar 

  28. 28

    Zheng Z, Liu C, Lan J, Gao X . Factorial analysis of root canal irrigants and cements on coronal microleakage after cementing metal post-cores. Hua Xi Kou Qiang Yi Xue Za Zhi 2014; 32: 242–245.

    PubMed  Google Scholar 

  29. 29

    Sarkis-Onofre R, Skupien J A, Cenci M S, Moraes R R, Pereira-Cenci T . The role of resin cement on bond strength of glass-fiber posts luted into root canals: a systematic review and meta-analysis of in vitro studies. Oper Dent 2014; 39: 31–44.

    Article  Google Scholar 

  30. 30

    Moraes A P, Sarkis-Onofre R, Moraes R R, Cenci M S, Soares C J, Pereira-Cenci T . Can silanization increase the retention of glass-fiber posts? A systematic review and meta-analysis of in vitro studies. Oper Dent 2015; 40: 567–580.

    Article  Google Scholar 

  31. 31

    Skupien J A, Sarkis-Onofre R, Cenci MS, de Moraes R R, Pereira-Cenci T . A systematic review of factors associated with the retention of glass fiber posts. Braz Oral Res 2015; 29: 1–8.

    Google Scholar 

  32. 32

    Abbott P V . Incidence of root fractures and methods used for post removal. Int Endod J 2002; 35: 63–67.

    Article  Google Scholar 

  33. 33

    Soares J A, Brito-Júnior M, Fonseca D R et al. Influence of luting agents on time required for cast post removal by ultrasound: an in vitro study. J Appl Oral Sci 2009; 17: 145–149.

    Article  Google Scholar 

  34. 34

    Emamieh S, Ghasemi A, Torabzadeh H . Hygroscopic expansion of aesthetic restorative materials: one-year report. J Dent (Tehran) 2011; 8: 25–32.

    Google Scholar 

  35. 35

    Sarkis-Onofre R, Jacinto Rde C, Boscato N, Cenci M S, Pereira-Cenci T . Cast metal vs. glass fibre posts: a randomized controlled trial with up to 3 years of follow up. J Dent 2014b; 42: 582–587.

    Article  Google Scholar 

  36. 36

    Hikasa T, Matsuka Y, Mine A et al. A 15-year clinical comparative study of the cumulative survival rate of cast metal core and resin core restorations luted with adhesive resin cement. Int J Prosthodont 2010; 23: 397–405.

    PubMed  Google Scholar 

  37. 37

    Pereira JR, do Valle A L, Shiratori F K, Ghizoni J S, Bonfante E A . The effect of post material on the characteristic strength of fatigued endodontically treated teeth. J Prosthet Dent 2014; 112: 1225–1230.

    Article  Google Scholar 

  38. 38

    Solomon C S, Osman Y I . In vitro comparison of endodontic posts in structurally compromised roots of maxillary incisors. SADJ 2011; 66: 220–223.

    PubMed  Google Scholar 

  39. 39

    Marchi G M, Mitsui F H, Cavalcanti A N . Effect of remaining dentine structure and thermal-mechanical aging on the fracture resistance of bovine roots with different post and core systems. Int Endod J 2008; 41: 969–976.

    Article  Google Scholar 

  40. 40

    Maccari P C, Cosme D C, Oshima H M, Burnett LH Jr, Shinkai R S . Fracture strength of endodontically treated teeth with flared root canals and restored with different post systems J Esthet Restor Dent 2007; 19: 30–36.

    Article  Google Scholar 

  41. 41

    Sonkesriya S, Olekar S T, Saravanan V, Somasunderam P, Chauhan R S, Chaurasia V R . An in vitro comparative evaluation of fracture resistance of custom made, metal, glass fiber reinforced and carbon reinforced posts in endodontically treated teeth. J Int Oral Health 2015; 7: 53–55.

    PubMed  PubMed Central  Google Scholar 

  42. 42

    Aggarwal R, Gupta S, Tandan A, Gupta N K, Dwivedi R, Aggarwal R . Comparative evaluation of fracture resistance of various post systems using different luting agents under tangential loading. J Oral Biol Craniofac Res 2013; 3: 63–67.

    Article  Google Scholar 

  43. 43

    Stankiewicz N R, Wilson P R . The ferrule effect: a literature review. Int Endod J 2002; 35: 575–581.

    Article  Google Scholar 

  44. 44

    Ferrari M, Vichi A, Fadda G M et al. A randomized controlled trial of endodontically treated and restored premolars. J Dent Res 2012; 91: 72S–78S.

    Article  Google Scholar 

  45. 45

    Fokkinga W A, Kreulen C M, Bronkhorst E M, Creugers N H . Up to 17-year controlled clinical study on post-and-cores and covering crowns. J Dent 2007; 35: 778–786.

    Article  Google Scholar 

  46. 46

    Al-Wahadni A, Gutteridge D L . An in vitro investigation into the effects of retained coronal dentine on the strength of a tooth restored with a cemented post and partial core restoration. Int Endod J 2002; 35: 913–918.

    Article  Google Scholar 

  47. 47

    Santana F R, Castro C G, Simamoto-Júnior P C et al. Influence of post system and remaining coronal tooth tissue on biomechanical behaviour of rootfilled molar teeth. Int Endod J 2011; 44: 386–394.

    Article  Google Scholar 

  48. 48

    Gegauff AG . Effect of crown lengthening and ferrule placement on static load failure of cemented cast post-cores and crowns. J Prosthet Dent 2000; 84: 169–179.

    Article  Google Scholar 

  49. 49

    Torbjorner A, Fransson B . A literature review on the prosthetic treatment of structurally compromised teeth. Int J Prosthodont 2004; 17: 369–376.

    PubMed  Google Scholar 

  50. 50

    Naumann M, Blankenstein F, Kiessling S, Dietrich T . Risk factors for failure of glass fiber-reinforced composite post restorations: a prospective observational clinical study. Eur J Oral Sci 2005; 113: 519–524.

    Article  Google Scholar 

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Correspondence to T. A. Owen.

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Owen, T., Barber, M. Direct or indirect post crowns to restore compromised teeth: a review of the literature. Br Dent J 224, 413–418 (2018). https://doi.org/10.1038/sj.bdj.2018.218

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