Casted Post & Core Restoration

Retention types of casted restoration:

1. Intra coronal retention
2. Extra coronal retention
3. Intraradicular retention

N.B:
• The mean of retention in post & core is (Intraradicular retention)..
• Sometimes 2 types of retention present in the same restoration..
• As a general role, post & core is performed in endodontically treated tooth..

Posts Classification:

Custom made
Ready made (prefabricated)

• According to the materials:

Metal Non-Metal
Stainless steel Fibrous core
Titanium Ceramic
Carbon fiber

• According to the outer surface:

 Serrated
 Smooth
 Screw

• According to the shape:

 Parallel sideded
 Tapered (root formed)

Core

Cast Metal Non Metal

Noble Composite
Base metal alloy Porcelain
Amalgam Glass ionomer
Case selection:
• Weighing the indications Vs contraindications..
• Weighing the benefits Vs risks..

Indication:
1. Endodontically treated tooth..
2. Obturated with G.P
3. Successfully clinically & radiographically..
Clinically Radiographically
1. Not sensitive to percussion (pressure).. 1. No root fracture..
2. No mobility.. 2. (Apical seal) Obturated well, no under or
3. No apical sensitivity.. over filling..
4. Amount of remaining tooth structure.. 3. No widening in PDL..
5. No sinuses with or without drainage.. 4. Intact Lamina dura..
5. No fracture, cracks, thinning of root dentin..
6. Root with adequate length to satisfy crown
/root ratio, which is minimally 1:1 & ideally
1:2
7. Straight root, not dilacerated..
8. No oblique or vertical fracture..
9. No Periapical Lesion

Contraindication:
Opposite..
N.B: Vertical & oblique fracture while horizontal fracture can be corrected.

Requirements:
1. G.P Filled root canal treated teeth..
2. Leaving 3 mm of G.P from the apical seal , the average is 4 mm , the range is from 3-5mm.
N.B: If we leave less than 3mm of G.P  break seal  entrance of bacteria

N.B:
 Retention of the post from fitness of the post in the inside wall of the root canal..
 In casted post & core One metal used..
 Post/core ratio:
• Minimally 1/1
• Ideally 2/1
 < 50% of remaining sound tooth structure Use Casted post and core
 > 50% of remaining sound tooth structure  Use prefabricated post & core e.x use parapost..
 The usage of post is providing retention to the core portion, not resistance..
 The weakest point is between the post & core esp. if they are of different materials..
 Radiographically, the alveolar crest separate between the crown & the root, soothe crown
from the tip of the cusp to crest of bone & the root is from the root apex to the alveolar crest..
 If we treat upper central incisor tooth endodontically & we need post & core , we use (casted
post & core) WHY???? (due to the Direction of force on the coronal portion)
 If the root canal is ∆ in cross section  use casted post & core why?? (more conservative).
 To prevent rotation of the post in the circular root canal  prepare (Keyway)  anti rotation
&  resistance..
  The ready made post is circular in cross section while the custom made can be triangular,
ribbon or oval..
Advantages of casted post & core over prefabricated posts:
1. More adaptable
2. Confided to different shapes & sizes
3. More conservative
4. Stronger @ the point between post & core

Disadvantages:
1. Needs more visits

Preparation of the post & core:

2 ways of dura lay pattern fabrication but both have the same preparation:
• Direct ( in the patient mouth)
• Indirect (in the lab)
- Prepare the remaining tooth structure as a normal preparation.
- Remove all the weak areas by diamond  minimally leave 1mm thickness of dentin to perform
(Root Stump).. if less  fracture
- Initially remove G.P by hot plugger , put rubber stopper @ least than 5mm of G.P from the
apex, insert the plugger & remove it while it’s hot
- The rest of G.P removed by:
1. Parapost drill  the shank is color coded according to diameter, the post should be less than
drill by 1mm for placement & cementation.. (N.B: be careful from perforation)
2. G.G has a safe cutting edge so we can apply pressure..
3. Pesso reamer  longer working area than the G.G
- It should be done by:
A) Clock wise
B) Pumping action in entrance & exist  to prevent dragging (locking) inside the root..
C) Without water coalent
- To solve dragging  remove it by hard instrument in anticlockwise direction..
• Factors affecting cast post retention (IMPORTANT):
• Length of the post
• Diameter of the post
• Shape of the post hole
• Type of cements
- Long post & core:
1.  retention
2. Stress distribution
3. less liability to root fracture
4.  adaptability

- Then prepare (Contrabevel)  bevel the outer surface of the crown WHY????
To provide (Ferrule design or ferrule effect): The complete embracing or encircling of the metal
collar around the tooth surface to increase its resistance to fracture by tighten tooth together..
N.B: The ferrule effect comes from :
 In the final restoration
 Contrabevel around the root stump
- Then prepare the antirotational groove inside the root canal , in the bulkest area or areas to
perform  keyway
 By fissure bur # 170
  Diameter 1mm
 Length 4 mm
 More common in the palatal region , we can do more than one groove if we need
Direct technique:
 No isolation (partial isolation with cotton rolls & saliva ejector).
 Saliva act as a separating & lubricating agent  prevent adhesion , so don’t dry the tooth well.
 Plastic sprue  trim them till they fit.
 Orientation notch  indicator of the facial surface
 Seration of the plastic spre  to provide retention to the dura lay
 2 dapping dishes
 Brush the duralay on the plastic sprue & return it back inside the root (N.B: Brush the monomer
on the sprue 1st then the polymer  runny or watery consistency..
 Pumping in & out  to avoid interloacking & setting of the dura lay in the undercut of the root.
 Prepare the core with dura lay
 Spruing
 Investement
 Burnout
 Casting
 Finishing but no polishing
 Try-in (passively)  with no pressure
 Cementation with low viscosity cement

Step by step Direct Post & Core Technique:

• The tooth is prepared prior to the pattern fabrication. A heated endodontic condensor
is used to safely remove the gutta percha (this is best accomplished at the same time
the endodontic therapy is rendered). Gates & Parapost drills are used to shape the
canals to an appropriate size and depth. The most common sizes used are Brown
Yellow and Red..

• The minimum length of the post is equal to the length of the clinical crown. The
recommended length is two-thirds the length of the root in bone while maintaining 5
mm of gutta-percha at the apex. Remember chances of a perforation increase as the
length of the post approaches the apex of the tooth.
• The prefabricated posts are inserted into the canals. In this case a precious metal post
is being used in the lingual canal because the canal diameter is only equivalent to a
brown sized Parapost (Gates #3 - see table). The precious metal posts are issued
from the Dispensing Window, and require an additional fee.
Gates Drills Parapost Drills

#3 Brown
#4 Yellow
#5 Red
#6 Black

(Pesso Reamers are not recommended in the preparation of teeth for post & cores).
An assistant holds the Duralay powder, liquid, and suction - while the core portion is made
in resin. First lubricate the remaining tooth structure with a water soluble lubricant
(Surgilube) then apply the resin. The assistant may move the suction near the resin,
evaporating monomer from its surface, thus preventing the resin from slumping or running.

• The completed resin core is allowed to polymerize - then it is prepared to the shape of
an ideal crown preparation
• Using conventional diamond instruments, water and suction, the resin core is prepared
in the same manner as a conventional preparation

• The preparation is completed to ideal form and in this case its path of insertion is
aligned with the preparation of tooth #11.

• The completed post & core pattern is submitted to the Service Laboratory for investing
& casting in gold alloy.

• The casting is cleaned and sandblasted with alumina oxide in preparation for try-in,
shaping, and cementation. The canals are dried and the casting inserted using light
pressure. Small shiny marks on the casting surface help indicate where adjustment
should be made.

• Once seated, the surface is "machined" or prepared with diamond instruments to

finalize preparation margins and blend the post & core with the tooth surface. It is
 advisable an assistant hold the post with an instrument to prevent it dislodging during
preparation - high speed suction may also be held near the area to evacuate debris.

• The completed post is cemented using a Jiffy tube to inject cement into the canals
which have been dried with Endodontic paper points

Indirect technique:
 Use the rubber base (polyether)  very stiff material with precaution:
• Close all the tooth undercuts
• Close the undersurface of the pontic
 Wire L-shape
 Try adhesive on the wire to hold the rubber base to the wire..
 Impression for the post  put the impression 1st in the coronal by lentulo spiral then insert the
wire.
 Vasline layer  as separating media because there is not slaiva..
 Prepare Escape way groove for cement material using rose head bur carbide..
N.B: when use long post, well filled, low viscosity cement with no escape way
1. Fracture of the root by hydraulic pressure
2. Unfitting (incomplete seating)

 We can use pin for extra mean of retention

 In multirooted tooth : one root for main retention & the other as an antirotation

2 cast post lock technique  if the canals are diverged from each other

Temporary restoration;
 Cotton fibers to ensure no cement in the apex
 Post
 Acrylic
 Polyarbonate crown form
1. Cue the wire clip in the form of L-shape
2. Make scratches
3. Put very little cotton fibers in the bottom part of the post hole.
4. Start relining the wire with white acryle (temporary)
5. Select a sutable size & shape of poly carbonate crown (trim cervically)
6. Fill it completely with white self cure acryle
 7. Insert it onto the ire clip post.
8. Wait until harden  remove  finish  polish  occlusal adjustment  temporary
cementation

Para post precaution:

 Level of the head away from occlusal by 4mm so when we put the core material 4mm than
occlusal reduction 2 mm reduction & 2 mm rest
 If we wanna remove from parapost, so from the apical region
 The head should be flat & round for retention , so if we remove from the head  sharp
stress conc. & no retention..
 If the level of the head above the cusp
• Rocking
• dislocation
• Cracks on the surface  fracture

Strawberry