Placing Posts in Teeth that Have Undergone Root Canal Treatment

Dr. RODRIGO CUNHA, Endodontist, Winnipeg MB

For many years dentists were taught that a large proportion of teeth that have undergone endodontic treatment should be restored with cast post and core and full coverage crown. But recently this thinking has changed.

In this episode of CDA Oasis Live, Dr. John O’Keefe invites Dr. Rodrigo Cunha, endodontist from Winnipeg and regular contributor to Oasis, to share his insights into the placing of posts in teeth that have undergone root canal treatment.

Here are the key takeaways from the conversation:

• We now know that endodontically treated teeth present with significantly different mechanical properties than vital teeth. The modifications in biomechanical properties and the structural integrity of the tooth can likely be attributed to volumetric loss of hard tissues, extent of carious lesion, fracture propagation, or even the final access cavity preparation and the shaping protocol used.
• It is beneficial to preserve as much tooth structure and biomechanical balance as possible so as not to compromise the long-term performance of the restored tooth.
• The main reasons for considering a post are to retain the core and to strengthen a tooth that has been weakened.
• When it comes to retaining the core, if you have a deep enough pulp chamber and there is enough remaining ferrule (between 2mm and 3mm) then you do not need a post in every single case.
• When a lot of tooth structure has been lost, especially in the cervical area, a fibre post may be necessary to reinforce the tooth.
• Despite numerous systematic reviews of randomized prospective and retrospective clinical trials that compared post-supported and post-free restorations of endodontically treated teeth, there is no clear evidence to support or reject the use of posts.
• Good clinical judgement plays an important role in evaluating how much tooth structure is left.

FURTHER RESOURCES

• Randomized Clinical Trial Comparing the Effects of Post Placement on Failure Rate of Postendodontic restorations: Preliminary Results of a Mean Period of 32 Months
• Composite Resin Core-Crown Reconstructions: An Up to 17-Year Follow-up of a Controlled Clinical Trial
• Postendodontic Restoration: Endodontic Post-and-Core or No Post At All?
• Current Options Concerning Endodontically-treated Teeth Restoration with the Adhesive Approach

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team