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Posts – when it all goes wrong! part 1: case assessment and management options Sam Rollings Brian Stevenson David Ricketts Dental Update 2024 40:2, 707-709.
Authors
SamRollings
BDS(Hons), MFDS RCS(Ed), MFGDP(UK)
SpR in Restorative Dentistry, Department of Restorative Dentistry, University of Aberdeen Dental School and Hospital, Cornhill Road, Aberdeen
Posts have been used for many years to retain restorations or cores for extra-coronal restorations in endodontically treated teeth. This article discusses the variety of post systems that are available and the incidence and reasons for failure of teeth that have been restored with posts. The treatment options available for the management of such failures are considered, in addition to the indications for both non-surgical and surgical management of endodontic failures. The attitudes of dentists and the perceived complications of attempting post removal are reviewed, along with the evidence to support the prevalence of complications.
Clinical Relevance: Failure of post-retained restorations is a relatively frequent finding due to failure of the restoration itself or the endodontic treatment. It is therefore important to understand and be aware of the various treatment options available, their indications and associated risks.
Article
Posts have been used to restore non-vital, endodontically treated teeth for over two centuries and they still play an important role in contemporary practice. Their use should not, however, be regarded as routine for all endodontically treated teeth and should only be used when there is insufficient coronal tooth tissue to gain retention for a restoration or core for a crown or bridge abutment. It is important to note that posts do not reinforce the roots of weakened, endodontically treated teeth. On the contrary, tooth preparation for post placement can result in further weakening of the root, predisposing it to a vertical root fracture (Figure 1) and can lead to iatrogenic perforation (Figure 2).1–4
If an anterior root-treated tooth has sufficient coronal tooth tissue remaining then there is minimal risk of a fracture compared to a similarly restored vital tooth. These teeth may simply be restored conservatively with a direct, bonded restoration which can, in certain situations, strengthen the tooth.5 Posts are also usually unnecessary in molar teeth as a 4 mm height of pulp chamber wall alone, or in some instances the coronal 1–2 mm of root canal (Nayyar Core), will be sufficient to retain the core.6 Post space preparation in posterior teeth carries with it the risk of lateral perforation because the roots are often curved and/or narrow, in particular the mesial roots of lower molar teeth and buccal roots of upper molar teeth. ‘It has however been recommended that most root-treated posterior teeth should have cuspal protection with a full occlusal coverage indirect restoration.’
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