104

ENDODONTIC
POSTS

Fiber Post Techniques

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for Anatomical Root Variations

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SE
T
he purpose of this article is to identify

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and describe the newer materials and While all brands of fiber posts
techniques deemed as viable alterna-

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tives to metallic post/cores, and to propose a appear to have these commonali-
rationale for the selection of one product or ties, they are not all the same....

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restorative technique protocol over others
for simple and complex post-endodontic

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restorations. These are indicated where re- While all brands of fiber posts appear to
Leendert (Len) maining coronal tooth structure is less than have these commonalities, they are not all

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SS
Boksman, DDS, 50% and/or the core strength is compro- the same; they can vary considerably from
BSc mised by the endodontic access opening. brand to brand in terms of composition and
Figure 1. Typical gingival darkening created by metal
post and core technique.
microstructure. The difference in the manu-

FE
Alejandro
BACKGROUND facturing process of the posts can significant-
Bertoldi
Hepburn, DDS Custom cast posts were first described more ly influence their mechanical properties,14,15
than 100 years ago, and utilized the optimal and thus their clinical performance. Fur-
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Enrique Kogan, impression techniques, casting, and cemen- thermore, a connection can be found be-
PR

DDS tation materials available at that time. In tween the data obtained with SEM observa-
most of the world, cast posts (still taught in tions of fiber posts and their clinical behav-
Manny some dental schools) have been supplanted ior. SEM photographs (Figures 2 to 4), taken
Friedman, BDS, in clinical practice by prefabricated posts at the same (700x) magnification, show the
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BChD made either of metallic alloys or from fiber- variations in size of fiber, orientation, num-
reinforced composite. In even a cursory ber of fibers, amount of composite, and the
/O

Waldemar de
review of the literature, the evidence-based relative percentages which varies from fiber
Rijk, PhD, DDS
support for a trend away from metal posts to post to fiber post. In fact, posts that have
D

fiber posts is abundant and conclusive: more imperfections in the matrix will have a
AN

l Fiber posts, regardless of brand, are

Figure 2. Cross section of a good quality post which
is highly loaded with fibers with no voids.
less compact and even structure, and thus are
anisotropic and have a modulus of elasticity weaker and less resistant to load stress.14
similar to that of dentin (~20 GPa), which Increases in the mechanical properties
allows the post to flex slightly (microscopi- (fracture strength) appear directly propor-
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cally) with the tooth and dissipate stress, tional to the density of fibers and to their
thereby reducing the likelihood of damage interface/bond to the matrix.16 In addition to
to the root.1-4
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influencing flexural strength, the fiber type,

l Fiber posts are not susceptible to gal- density, and uniformity of microstructure
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vanic or corrosion activity; the latter of also affect the radiopacity and fatigue resist-
which is responsible for a high percentage ance. Figure 5 shows the relative radiopacity
of failures with cast posts5 which, in turn, of various fiber posts side by side, and Figures
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fail twice as often (clinically) as do prefabri- 6 to 8 demonstrate the same variation in an

cated metal posts.6 extracted tooth that is prepared for a 1.5 mm
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l Fiber posts are available in translucent tapered fiber post. It is obvious that the
Figure 3. Cross section of a poor quality post
and tooth-colored versions (the original showing lower fiber loading with voids in the matrix. Macro-Lock Illusion X-RO (CLINICIANS
black carbon posts are pass), which are aes- CHOICE) is the most radiopaque in this sam-
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thetically invisible under all ceramic pling of fiber posts (Figure 7).
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crowns, veneers and resin restorations, and Quartz fibers are among the most ra -
also mitigate the effects of the dark root syn- diopaque fibers being used,17,18 and the
drome (Figure 1).7,8 quartz fiber posts have proven superior in
l Fiber posts (excepting a South Amer - fatigue resistance to glass fiber posts15 and to
ican post design that has a metal wire running metal posts.19 Fatigue tests can be considered
through its long axis) are more easily and safe- as the most relevant methodological stan-
ly removed by hollowing them out from the dard for evaluating and predicting the behav-
inside, should re-treatment ever become nec- ior in an oral environment.18 The in vitro
essary.9-12 In fact, cemented metal posts may studies that more than any other permit the
further limit or complicate endodontic treat- Figure 4. Cross section of a fiber post with low-fiber fair prediction of yielding and, therefore, the
ment options if these become necessary.13 and high-resin matrix content. continued on page 106

DENTISTRYTODAY.COM MAY 2011

106

ENDODONTIC POSTS

Fiber Post Techniques... canal, while addressing the inherent

continued from page 104 challenges, which include C-factor
stress and S-factor stress,43 polymer-
long-term behavior of the restoration, ization shrinkage and, presumably,
are the fatigue tests.20,21 microleakage.
Into the 1970s, it was hoped that Most fiber posts on the market
metal posts could help reinforce weak- come in cylindrical sizes that mimic

LY
ened endodontically-treated teeth. In their metallic ancestors, so that the
Figure 5. Radiograph of various shapes,
the 1980s, Sorensen, et al20 surmised designs, tapers of early radio-apparent fiber
practitioner may use the drills already

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otherwise. Today there is a growing posts. purchased. However, as previously dis-
body of in vitro evidence that if prop- cussed, a tapered preparation is the

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erly placed, low modulus restorations most noninvasive. Unlike fiber posts,
(quartz fiber posts with bonded com- Figure 9. Scanning electron microscope as the diameter of metal posts increas-

SE
posite cores) with varying amounts of photograph of intimate adaptation of fiber es, so does the stress transfer to the
remaining tooth structure can, in fact, post, dual cure resin cement and root dentin. tooth,44 and so, logically, does the like-
provide some restrengthening of lihood of root splits.

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weakened teeth restored with MOD There are some tapered quartz
restorations, veneers, or full-coverage fiber posts that come in extra large

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techniques.22-26 Figure 9 shows a high- sizes that range from 0.8 mm at the
power SEM of the adaptation possible apical tip to 2.3 mm at the coronal

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with an appropriately sized bonded Figure 6. Radiograph of typical fiber post extreme (DT Light-Post [RTD, BISCO]
fiber post creating a monoblock. A when prepared for a 1.5 mm taper. and Macro-Lock Post [RTD]). These

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ferrule of 2 mm has to be provided for sizes exceed the diameters available in
the reconstruction of endodontically most brands, and are capable of fitting

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SS
treated teeth by post and core tech- most root canal treatments without
niques. (Studies show that increasing Figure 10. Parallel-sided fiber post of 1.5 further instrumentation.
mm does not seat in same tooth without
the length of a ferrule from 1 to 1.5 more apical removal of dentin structurally
The authors will now describe
mm in a quartz fiber post does not sig-
nificantly increase fracture loads, but
an increase to 2 mm results in higher
FE
weakening the tooth. and suggest an approach and tech-
nique for the inevitable variations
presented by prepared and filled root
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fracture thresholds.) canals which fall into 3 proposed
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Now the clinical observation of car- treatment categories.

bon27-30 or glass and quartz fiber31-34 Figure 7. The Macro-Lock Illusion X-RO
post restorations offer admirable per- (CLINICIANS CHOICE) shows excellent THE SIMPLE CANAL
radiopacity at 1.5 mm post space
formances at 7 to 11 years conclusion,35 preparation. In a simple case, where the canal
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and the difference in failure ratespar- treatment results in the typical ta-
ticularly catastrophic failure rates pered conservative shape (less than
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between fiber posts and cast posts is no 25% larger than the fiber post [Figure
less compelling at 4 years service.36 12]), a single fiber post can be inserted
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Figure 11. A 1.5 mm parallel post with

The placement of a single fiber lateral serrations and core bulk again and covered with a composite core
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post in a relatively round and mini- requires more apical dentin removal to seat build up in preparation for the pros-
mally tapered conservative root canal to same length as the tapered Macro-Lock thetic restoration. The clinical proto-
Illusion X-RO (compare to Figure 7).
has been described in many articles col for this type of case is as follows:
and is now appearing in textbooks. All procedures inside the root ca-
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There is evidence that (unlike metal nal should focus on the bottom-up
predecessors) there is no difference in Figure 8. Same tooth radiographed with a approach; the canal is prepared with
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the performance between tapered and popular radio-apparent fiber post. the matching sized post drills and
parallel fiber posts.37,38 However, it is posts, and all remnants of gutta-per-
SO

self-evident to an experienced clini- Circular parallel post systems are cha must be removed from the walls
cian that parallel posts may often only effective in the most apical por- of the post space to facilitate bonding.
require the removal of additional tion of the post space, because the The fiber post is generally shortened
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dentin and the creation of acute inter- majority of prepared post spaces to the height of the core with a dia-
nal angles (stress magnets). There - demonstrate considerable flare in the mond bur before the bonding proce-
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fore, the tapered apical/parallel body coronal half. Similarly, when the root dure is started, but it can also be cut
shape is preferable39-41 if only for the canal is elliptical, a parallel-sided post with a diamond bur after the core is
sake of dentin conservation. Figures will not be effective unless the canal is cured. If using a self-curing resin
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10 and 11 show the same tooth as considerably enlarged,42 thereby Figure 12. A conservative nonflared canal is cement, the post should always be cut
FO

above, prepared for a tapered 1.5 mm needlessly removing extra dentin. ideal for a conservative flared fiber post to length first, so as not to vibrate the
fiber post. It is obvious from the radi- From a clinical perspective, when preparation. post while the cement may be setting.
ographs that more tooth structure at assessing posts that have failed, many Fiber posts can be cut to length after
the apical end of the canal would need are in fact cemented or bonded to cated posts available (in limited mar- the core is placed, but color changing
to be sacrificed to allow the parallel areas in the canal still occupied by ket areas) that are designed with a posts are unique. A color changing
1.5 mm posts to seat to the same gutta-percha. One of the causes for the rounded, tapered apical extremity, post should be cut 1.5 mm short of the
length, needlessly weakening the lack of resultant retention is due to and an oval coronal section (Peer- anticipated coronal extent of the core,
remaining root structure. this oversight, which is a direct result lessPost [SybronEndo] and ELLIPSON and thus be buried in the core com-
So, then, what is the contempo- of preparing a round canal space with [RTD]). posite. This is done to prevent reap-
rary technology protocol, when faced a rotary instrument in a canal which The low modulus approach needs pearance of the color under translu-
with a flared, ovoid, or figure-8 canal? is never round. There are 2 prefabri- to be adaptable to the over-flared cent ceramics due to exposure to

DENTISTRYTODAY.COM MAY 2011

intraoral temperature changes
when the patient ingests cold
beverages or food. The clinical
presentation and treatment
of a case that is typical for the
simple canal is shown in
Figures 13a to 13n. The tooth

LY
is isolated and gutta-percha is
removed with a small starter

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drill (Figure 13b), and the post
space is created with the

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appropriate size taper drill
(Figure 13c). Care should be

SE
taken to match the post, as
close as possible, to the size of
the existing canal space

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rather than over preparing
the canal for a large post. At

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this time, all remnants of gut-
ta-percha should be removed

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and verified visually with
magnification. (Some practi-

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tioners use chloroform to dis-
solve any remaining gutta-

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SS
percha in the post space area.)
The fiber post (Macro-Lock

All procedures FE
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inside the root
PR

canal should focus

on the bottom-up
approach....
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/O

Illusion X-RO is tried in the

canal (Figure 13d). Then, it is
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trimmed to length with a dia-

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mond bur to prevent chatter

and possible damage to the
post. To decontaminate the
post after try-in and length
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adjustment, it is cleaned with

alcohol prior to bonding. The
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canal is acid etched by plac-

ing the acid gel from the bot-
SO

tom up using a 20- or 22-

gauge needle tip (Figure 13e).
This is done to keep an air
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lock from forming below the

etchant, which would pre-
PE

vent etching of the entire

canal space. It has been
shown that agitating the acid
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with a microbrush during

FO

this 15-second procedure in -

creases bond strength. The
canal is rinsed with water,
again from the bottom up,
using a 20- or 22-gauge needle
adapted to either a Stropko
Irrigator (CLINICIANS CHO -
ICE) or TriAway Adaptor (Ul -
tradent Products), to thor-
oughly wash and remove the
acid gel out of the canal space.
108

ENDODONTIC POSTS

a b c d e

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Figure 13a. Clinical presentation of Figure 13b. A small starter drill is Figure 13c. The appropriate size Figure 13d. The Macro-Lock Illusion Figure 13e. An acid gel (Ultra-Etch

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failed post and core crown on upper used to initiate removal of the tapered Macro-Lock drill is used to X-RO post inserted and checked for fit. [Ultradent Products]) is injected from
right central incisor. gutta-percha. maximize size while minimizing Notice the small space between the the bottom of the post space up to

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dentin removal. post and the walls of the post prepara- the cavosurface margin by using a
tion. A diamond is then used to short- 20- or 22-gauge needle to avoid air
en the post to the desired length. entrapment.

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f g h i j

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O
Figure 13f. After water rinsing from Figure 13g. After air-thinning the Figure 13h. The bonding agent is Figure 13i. After evaporating the Figure 13j. Using a lentulo-spiral to
the bottom of the canal up, and light bonding agent from the bottom up, applied to the post with a solvent and air thinning, the bonding insert the dual cure resin cement

I
SS
drying, the canal is checked for the canal is checked for excess microbrush. agent is light-cured. will accelerate the set. It is best to
excess moisture with a paper point; bonding agent with a paper point, and inject using a 20- to 22-gauge
the bonding agent is placed in the the bonding agent is cured with a needle (Endo-Eze [Ultradent
canal and lightly agitated to increase high output curing light for 20 Products]) from the bottom up to

FE
the bond strength to the dentin. seconds. eliminate air entrapment.

This cannot be achieved

with a typical 3-way sy - k l m n
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ringe, which can leave
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some acid in the canal,

interfering with the chem-
ical setting reaction of a
dual- or self-cure cement.
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The canal is lightly dried

using air from the bottom
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up and then double Figure 13k. After insertion of the Figure 13l. After injecting and hand Figure 13m. The clinical preparation Figure 13n. The final ceramic
fiber post into the dual-cured resin sculpting the core material around of the fiber post and core for restorations (Zirconia [ZirconZahn]) on
checked with a paper cement and placed to length, the
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the remainder of the fiber post, the full-coverage restoration is shown in the 2 upper central incisors.
point. The adhesive bond- cement is cured with light down the composite resin is light-cured. this intraoral photograph.
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ing agent is placed with a long axis of the fiber post for 30
microbrush and agitated seconds.
into the opened tubules of
the root canal (Figure 13f). Air is deliv- (Figure 13i). Then, after the dual cure
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ered from the bottom up and excess resin cement is placed into the canal
bonding agent and pooling is prevent- with Skini Syringe mated to an Endo-
There are many recommendations being made for the
selection of cementation media and placement technique.
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ed by inserting a paper point to absorb Eze tip (Ultradent) (Figure 13j), the
any excess. The bonding agent is then post is inserted and the dual cure resin
SO

light-cured with a high-power, broad cement is light-cured for 30 seconds

spectrum LED curing light for at least (Figure 13k). It is best to inject the All-Bond 2 [BISCO] or One-Step [BIS - etching cements46-48 and resin-rein-
30 seconds (Figure 13g). It must be dual cure resin cement from the bot- CO], SealBond Ultima [RTD], MPa forced glass ionomer cements,49 partic-
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remembered that light intensity for tom up rather than using the lentulo [CLINICIANS CHOICE] respectively) ularly when using macroretentive
some curing lights falls drastically spiral. This prevents any possible air in conjunction with dual cure or quartz fiber posts (Macro-Lock Illusion
PE

with distance, so the cure must be ade- entrapment and prevents the acceler- chemical cure resin cement, as being X-RO). However, it should also be no-
quate. There are only 3 possible solu- ation of set caused by the lentulo-spi- superior to self-etching or self-adhe- ted that some of the comparative in
tions for this: (1) a dual (photo and ral drill. The core material is injected sive cement formulas.45 Clinical suc- vitro bond strength studies (to dentin)
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chemical) activation adhesive, (2) con- around the post, and then light-cured cess with these also assumes proven show these newer generations of
FO

ducting the light through the post (Figure 13l). The final preparation of chemical compatibility between the cements to be inferior to the total-
and photoactivate it together with the the core for the patient is shown in adhesive and the resin cement, and etch/moist-bonding dual cure cemen-
resin cement, or (3) light-curing ade- Figure 13m and the final Zirconia meticulous isolation, good access, tation technique. Furthermore, a post
quately with a high-power light (such (ZirconZahn) (ceramic) restorations vision, and technique. This is easy in inserted like this should also have high
as the VALO [Ultradent Products]) in are shown in Figure 13n. the in vitro laboratory, but not always flexural strength (minimum 1,500
its plasma emulation mode, 3 seconds There are many recommenda- so easy in vivo. MPa) since it wont have the mechani-
at over 3,000 mW/ cm2. The point here tions being made for the selection of In cases where access and/or visi- cal reinforcement that the adhesive
is that if light-cured adhesives are cementation media and placement bility and/or good moisture control are cementation provides.
used, undercuring will lead to failure. technique. Standard bonding tests compromised, some post manufactur- Because larger, tapered, and even
Next, bonding agent is applied to the would support the use of a fourth-or ers and clinicians/researchers report double-tapered fiber posts are now
post (Figure 13h) and light-cured fifth-generation adhesive system (ie, good results using self-adhesive, self- offered, and these are mechanically

DENTISTRYTODAY.COM MAY 2011

 109

ENDODONTIC POSTS

a b c d

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Figure 15a. In this type of canal, the Figure 15b. The Macro-Lock Illusion Figure 15c. Using a brush, a water Figure 15d. A light-cured composite

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tooth is isolated and prepared to a X-RO post is verified for fitnotice soluble separating medium is (such as Grandio [VOCO]) is adapted
post size that will fit at the apical how the canal flares and there is applied to the post space. to the prebonded post.

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end without overly enlarging the excess space at the coronal aspect.
prepared canal.

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e f g h
Figure 14. A typical cross section

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of a tooth with a mildly flared
canal which results in some
excess space around the

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proposed fiber post in the coronal
area.

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compatible with the remain- Figure 15e. The post and hybrid Figure 15f. After light-curing, the Figure 15g. The custom fiber post Figure 15h. After a thorough rinsing

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composite are seated into the custom fiber post and core is and core, the result of creating a of the prepared canal space and the
ing tooth structure, good close prepared post space creating a cus- removedthis mitigates the S-factor core build-down into the canal. custom fiber post and core, the core
adaptation of the post to the

I
tom post. by allowing the resin to shrink is reseated in the canal and the

SS
post space can routinely be toward the post. labial aspect marked with a pencil.
achieved, with a minimum of
cement thickness,40,41 thus i j k l
minimizing the S-factor. It is
the more flared spaces that
are addressed now.
FE
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THE ANATOMICAL POST

AND CORE
Polymerization shrinkage, Figure 15i. The canal is etched and Figure 15j. Labial view of Figure 15k. The post is seated into Figure 15l. The margins of the tooth
and the stresses associated the etchant is agitated with a Macro-Lock Illusion X-RO post the canal with the pencil marking preparation are refreshed and
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with that (the C-factor and S- microbrush, rinsed from the bottom inserted into the cement. placed labially. The custom posts etched prior to bonding the core.
up, and a bonding agent is agitated allow for a minimal thickness of
factor), are a big considera- into the dentin and light-cured.
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luting cement thus, minimizing the

tion in all bonding/restora- S-factor. Excess cement is removed
tive procedures, and nowhere before light polymerization.
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is the C-factor higher than it

is in post cementation,43 be - m n o p
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cause of the high number of

involved surfaces and un-
bounded surfaces. Even
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though composite resin core

materials generally have
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more filler and, therefore,

higher strength than resin Figure 15m. Bonding resin is placed Figure 15n. This photograph shows Figure 15o. The core is finalized
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Figure 15p. The final ceramic

cements, the polymerization on the dentin prior to hand sculpting the hand-sculpted, custom-fabricated with a coarse diamond bur to length restoration e.maxPress (Ivoclar
shrinkage stress is higher the composite resin core, then the fiber post and core after hand and depth requirements for the Vivadent) with feldspathic overlay
core build up is shaped/completed sculpting and light-curing. ceramic crown. over the custom fiber post and core
with 70% filler than that and light-cured. is shown in this photograph.
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with 10% filler.50 This may

seem counterintuitive to
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most dentists, but the objective is to a diamond bur to match an analog coronal circumference 25% to 50% as Grandio [VOCO]) is adapted to the
utilize a technique that compensates achieved through a separate proce- greater than that of the largest fiber post prebonded post (Figure 15d), which is
for the inherent deficiencies of some dure. The results suggest that the vol- (by itself) available, the authors sug- then inserted into the root canal space
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materials and, in fact, actually capital- ume of cement is minimized, and the gest the following protocol. (Figure 15e). The composite is light-
FO

izes on them without becoming clini- retentive surfaces of the post are not In this clinical case, the canal has cured through the light-conductive
cally cumbersome, time consuming, compromised. However, no informa- a moderate flare with the above crite- fiber post, and the post is removed
or with the integration of outside lab- tion is offered regarding the effects ria. The tooth is isolated, and the canal from the canal (Figures 15f and 15g).
oratory fees. that whittling a round (tapered or par- is prepared as previously with a size When performing this technique, the
In an earnest attempt to address allel) post brings to the other mechan- appropriate drill (Figure 15a). After clinician must look for undercuts
these factors, Grande, et al51 and ical properties of the fiber post, such the canal is thoroughly cleaned, the before creating the core build-down.
Plotino, et al52 have described chair- as structural integrity. fiber post is inserted and the fit veri- It wont be possible to remove the post
side techniques for adapting prefabri- In the mildly flared space (Figure fied (Figure 15b). A water soluble sep- if cured in those undercuts, and the
cated fiber posts to ribbon-like, oval, 14), we can create a composite core arating medium is applied to the post procedure will have to be repeated,
or ovoid canal spaces by remodeling; build-down followed by the core space (Figure 15c), a light-curable possibly injuring the post. After veri-
in essence, by whittling the post with build-up. In the flared canal with a hybrid composite core material (such fying the position (Figure 15h) by

MAY 2011 DENTISTRYTODAY.COM

110

ENDODONTIC POSTS

a b c d e

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Figure 16a. Photo of failed cast Figure 16b. With the gutta-percha Figure 16c. The existing canal space Figure 16d. The bonding resin is Figure 16e. The dual-cured resin
post and core with widely flared and cement removed, no other was acid-etched with phosphoric acid thoroughly cured with a high output cement (Rebilda DC [VOCO]) is then

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canalnote the thickness of the dentin was removed, and the largest for 15 seconds and rinsed from the light-curing unit. injected from the bottom of the
prior cement used. diameter fiber post that fit at the bottom up with a 20- to 22-gauge nee- preparation to the coronal aspect.
apex was the starting point. dle tip. The bonding resin was agitated

SE
into the dentin, air-thinned from the
bottom up, verified with a paper point.

f g h i j

U
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N
O
Figure 16f. The master prebonded Figure 16g. Prebonded Fibercones Figure 16h. The core composite is Figure 16i. The occlusal view of the Figure 16j. The intraoral clinical view

I
injected between and around the reinforced fiber post and core with

SS
post is inserted to length into the (RTD) are inserted prior to light- of the reinforced fiber post as
dual cure resin cement. curing to minimize the amount of Fibercones and central master rubber dam still in place. prepared for the full coverage
dual cure resin and to strengthen fiber post and hand sculpted prior to ceramic restoration.
the post. light-curing.

marking the labial with a pencil for

orientation, the canal is thoroughly
It is a direct-indirect technique,
and has shown optimistic results.53-55
FE
In contemporary dental practice, there is no remaining
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rinsed and the build down is rinsed to
reason to use metallic posts, custom or prefabricated.
PR

remove the water soluble separating THE POST WITH

medium. As in the first clinical proto- ACCESSORY POSTS
col, the canal is etched with a micro- Now, in the case where the coronal cir-
brush which is agitated in the canal cumference has a wide flare of more than Figure 17a shows the typical trian- Published studies demonstrate
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(Figure 15i), rinsed from the bottom 50% greater than that of the largest fiber gular shape encountered when restor- the other benefits of this Accessory Post
up, dried from the bottom up, and any post available, or the practitioner is ing anterior teeth. Figure 17b shows a technique:
/O

excess water removed with a paper working with a ribbon, ovoid, or tri- Macro-Lock Illusion X-RO with an l Minimizes shrinkage in flared

point. The light-cured bonding agent angular canal, the suggested tech- accessory Fibercone placed in the lin- canals and, therefore, gap formation60
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is applied and fully cured as in the pre- nique is as follows: gual slot area. The final clinical photo- l Reduces the need for drilling in
AN

vious protocol. The dual cure resin As can be seen from Figure 16a, graph is shown in Figure 17c. This we order to adapt posts to root cavity61
cement is placed in the canal, the core the existing canal in which a cast post will call the (direct) accessory post tech- (minimizes dentin removal)
build-down is inserted (Figures 15j and and core failed, is over prepared and nique, in which the master fiber l Reduces the thickness of cement

15k), and thoroughly light-cured. widely tapered at the coronal aspect. postsize-selected for its fit at the api- and increased fracture resistance.60
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After cementation, the dentin is By following the previous methodolo- cal end of the spaceis accompanied Fiber posts, associated with com-
refreshed with a diamond, the surface gy, the canal is prepared and the fit of by one or more slender, tapered acces- posite resin or with accessory fiber
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etched (Figure 15l), rinsed and bonded the fiber post is assessed (Figure 16b). sory posts (eg, Fibercone). The clinician posts, seem to be more indicated as an
(Figure 15m); then, the core material is The large amount of resin cement will may draw an immediate parallel to alternative to cast post and core in
SO

adapted and light-cured. The resultant need to be minimized to decrease the their training with gutta percha cones. flared roots, because of the lower risk
free-handed core is shown in Figure shrinkage factor, and the cement and RTD translucent quartz fiber posts (DT of catastrophic failures and better
15n, which is modified with a tapered core material will need strengthen- Light-Post and Macro-Lock Illusion X- stress distribution.62
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coarse round ended diamond (Figure ing. The canal is etched, rinsed, and RO) have been shown to have limited It is possible to conclude that use
15o), and the final ceramic crown (IPS dried lightly; the compatible bonding but relatively superior transmission of of the fiber post, associated with
PE

e.max [Ivoclar Vivadent]) over the cus- agent is agitated into the canal (Figure the polymerization light energy56-58 accessory posts, is the method of
tom-fabricated fiber post and core is 16c); and light-cured (Figure 16d). down into the post-restorative space, a choice for reinforcing structurally
shown in Figure 15p. After direct injection of the dual- property which is an important attrib- weakened roots, and provides an im-
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This way, any shrinkage in the cured resin cement (Figure 16e), the ute and would necessarily disqualify provement in the load carrying ability
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build-down is now in free space, not prebonded fiber post is inserted the use of many other (less conductive) of the restored root is validated, as
between the tooth and the restoration, (Figure 16f), and prebonded Fiber - fiber posts for this technique. opposed to the use of one single inad-
neutralizing the S-factor effect. And it cones (RTD) are inserted (Figure 16g). In addition, the flexural and com- equately fitting post.63,64
assures that the cement thickness will Then, core composite is injected be - pressive strength of the factory-made
be minimal and uniform.48 In most tween and around the Fibercones and composite (99.9% cross-linked) are SUMMARY
cases, the air-inhibited layer on the central master fiber post and hand higher than a composite hand-cured In contemporary dental practice,
build-down can remain intact. If in sculpted prior to light-curing (Figure by light energy at chairside. In com- there is no remaining reason to use
doubt, the excess cement and remain- 16h). Lastly, the core build up is parison, the cross-linked networks metallic posts, custom or prefabricat-
ing tooth structure can be refreshed shaped, light-cured, and prepared to during polymerization and degree of ed. Many cases that several years ago
before the bonding agent and core final shape with diamonds (Figures conversion for most direct resin mate- would have required a retentive post
build-up composite is applied. 16i and 16j). rials ranges from 45% to 70%.59 will not require that post today,

DENTISTRYTODAY.COM MAY 2011

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ENDODONTIC POSTS

55. Grandini S, Sapio S, Simonetti M. Use of anatom-

a b c ic post and core for reconstructing an endodonti-
cally treated tooth: a case report. J Adhes Dent.
2003;5:243-247.
56. Miller MB. Fiber posts. In: Reality Now. Houston,
TX: Reality Publishing; 2006: 643-660.
57. Christensen GJ. Posts a shift away from metal?
CRA Newsletter. 2004;28(5):1-3.

LY
58. Goracci C, Corciolani G, Vishi A, et al. Light-trans-
mitting ability of marketed fiber posts. J Dent
Res. 2008;87:1122-1126.
59. Lambert D. A recipe for success with posterior

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composites utilizing preheated resins. Oral
Health. 2009;99:67.
60. Porciani PF, Vano M, Radovic I, et al. Fracture

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Figure 17a. The typical triangular shape of Figure 17b. This anatomic space is ideal for Figure 17c. Postoperative photograph of the resistance of fiber posts: combinations of sever-
anterior root canal space after endodontic the placement of a Macro-Lock Illusion X-RO Fibercone and auxiliary Fibercone in the al small posts vs. standardized single post. Am J
preparation. fiber post complemented with an auxiliary triangular shaped canal. Dent. 2008;21:373-376.

SE
61. Maceri F, Martignoni M, Vairo G. Mechanical
Fibercone to decrease the amount of dual
behaviour of endodontic restorations with multi-
cure resin used and fortify the restoration. ple prefabricated posts: a finite-element
approach. J Biomech. 2007;40:2386-2398.

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14. Ferrari M, Scotti R. Fiber Posts: Characteristics 35. Ferrari M, Cagidiaco MC, Goracci C, et al. Long-term 62. Raposo LHA, Silva GR, Santos-Filho PCF, et al.
because of the many improvements in and Clinical Applications. Paris, France: Masson retrospective study of the clinical performance of Effect of posts and materials on flared teeths
Publishing; 2002:26. fiber posts. Am J Dent. 2007;20:287-291. mechanical behavior. J Dent Res. 2008;87(B,
bonding agents and composite resin 15. Grandini S, Goracci C, Monticelli F, et al. An eval- 36. Ferrari M, Vichi A, Garca-Godoy F. Clinical evalua-

AL
special issue). Abstract 1862.
restoratives. However, in cases where uation, using a three-point bending test, of the tion of fiber-reinforced epoxy resin posts and cast 63. Braz R, Conceio AAB, Conceio EN, et al.
fatigue resistance of certain fiber posts. Il post and cores. Am J Dent. 2000;13(special Evaluation of reinforcement materials used on
less than 50% of coronal tooth struc- Dentista Moderno. March 2004;70-74. issue):15B-18B. filling of weakened roots. J Dent Res. 2005;84(A,

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ture remainsor in other cases 16. Vallittu PK, Lassila VP, Lappalainen R. Acrylic 37. Naumann M, Blankenstein F, Dietrich T. Survival special issue). Abstract 1733.
resin-fiber compositePart 1: The effect of fiber of glass fibre reinforced composite post restora- 64. Porciani PF, Grandini S, Papacchini F, et al. The fit of
wherein the judgment of the clinician concentration on fracture resistance. J Prosthet tions after 2 yearsan observational clinical

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two fiber posts into the root canal space enlarged
a post is indicatedthere are now aes- Dent. 1994;71:607-612. study. J Dent. 2005;33:305-312. with rotary NiTi files at four different levels.
17. Denny D, Heaven T, Broome JC, et al. Radiopacity 38. Signore A, Benedicenti S, Kaitsas V, et al. Long- International Dentistry S Afr. 2007;9(1):44-50.
thetic, non-corrosive, fracture resist-

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of luting cements and endodontic posts. J Dent term survival of endodontically treated, maxillary

SS
ant and radiopaque alternatives for all Res. 2005;84(A, special issue). Abstract 0675. anterior teeth restored with either tapered or par-
18. McClendon K, Ripps A, Fan Y. Comparative study allel-sided glass-fiber posts and full-ceramic Dr. Boksman is an adjunct clinical professor
varieties that save time and money on radiopacity of fiber posts and resin cements. crown coverage. J Dent. 2009;37:115-121.
at the Schulich School of Medicine and
without compromise. Their most J Dent Res. 2010;84(A, special issue). Abstract 39. Dietschi D, Duc O, Krejci I, et al. Biomechanical
Dentistry, and has a private practice in

FE
0253. considerations for the restoration of endodontical-
compelling advantage, regardless of 19. Wiskott HW, Meyer M, Perriard J, et al. Rotational ly treated teeth: a systematic review of the litera- London, Ontario, Canada. He can be reached
the geometry or amount of residual fatigue-resistance of seven post types anchored on turePart 1. Composition and micro- and at [email protected].
natural teeth. Dent Mater. 2007;23:1412-1419. macrostructure alterations. Quintessence Int.
tooth structure, is the protection from
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20. Sorensen JA, Ahn SG, Berge H-X, Edelhoff D. 2007;38:733-743. Disclosure: Dr. Boksman has a paid part-time
root fracture that a low modulus Selection criteria for post and core materials in 40. Baldissara P, Zicari F, Ciocca L, et al. Effect of fiber consultancy position as the director of clinical
the restoration of endodontically treated teeth. post emerging diameter on composite core stabi- affairs for Clinical Research Dental and CLINI-
PR

restoration provides. Dent Materials. 2001;15:67-84. lization. J Dent Res. 2007;86(A, special issue).
CIANS CHOICE.
In selecting the materials (posts, 21. Wiskott WH, Nicholls JI, Belser UC. Stress Abstract 2623.
fatigue: basic principles and prosthodontic impli- 41. Boudrias P, Sakkal S, Petrova Y, et al. Anatomical
resins) for these techniques, the den- cations. Int J Prosthodont. 1995;8:105-116. post design applied to quartz fiber/epoxy technol-
tist is advised not to cut corners, and 22. Hajizadeh H, Namazikhah MS, Moghaddas MJ, et ogy: a conservative approach. Oral Health. Dr. Hepburn works as adjunct professor at the
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al. Effect of posts on the fracture resistance of 2001;91:9-20. operative dentistry department of the University
to seek the strongest and most load-cycled endodontically-treated premolars 42. Rosenstiel SF, Land MF, Fujimoto J. Contemporary of Buenos Aires Dental School (Buenos Aires,
radiopaque products available.! restored with direct composite resin. J Contemp
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Fixed Prosthodontics. 3rd ed. St. Louis, MO: Argentina), and at the Oral Rehabilitation
Dent Pract. 2009;10:10-17. Mosby; 2001:279. Postgrade Career in the University del Desarrollo
23. Salameh Z, Sorrentino R, Ounsi HF, et al. The 43. Breschi L, Mazzoni A, De Stefano D, et al.
effect of different full-coverage crown systems on Adhesion to intraradicular dentin: a review. Journal
Dental School (Concepcin, Chile). He has a pri-
References
D

fracture resistance and failure pattern of of Adhesion Science and Technology. vate practice in Buenos Aires, Argentina. He can
1. Adanir N, Belli S. Stress analysis of a maxillary
central incisor restored with different posts. Eur J endodontically treated maxillary incisors restored 2009;23:1053-1083. be reached at [email protected].
AN

Dent. 2007;1:67-71. with and without glass fiber posts. J Endod. 44. Rodrguez-Cervantes PJ, Sancho-Bru JL, Barjau-
2. Albuquerque Rde C, Polleto LT, Fontana RH, et al. 2008;34:842-846. Escribano A, et al. Influence of prefabricated post Disclosure: Dr. Hepburn is a consultant for
Stress analysis of an upper central incisor 24. Dikbas I, Tanalp J, Ozel E, et al. Evaluation of the dimensions on restored maxillary central incisors. VOCO GmbH (Germany).
restored with different posts. J Oral Rehabil. effect of different ferrule designs on the fracture J Oral Rehabil. 2007;34:141-152.
2003;30:936-943. resistance of endodontically treated maxillary 45. Mazzoni A, Marchesi G, Cadenaro M., et al. Push-
AL

3. Lanza A, Aversa R, Rengo S, et al. 3D FEA of central incisors incorporating fiber posts, com- out stress for fibre posts luted using different
cemented steel, glass and carbon posts in a posite cores and crown restorations. J Contemp adhesive strategies. Eur J Oral Sci. Dr. Kogan works as a professor of Restorative
maxillary incisor. Dent Mater. 2005;21:709-715. Dent Pract. 2007;8:62-69. 2009;117:447-453. Dentistry Universidad Tecnolgica de Mexico,
4. Okamoto K, Ino T, Iwase N, et al. Three-dimen- 25. DArcangelo C, De Angelis F, Vadini M, et al. 46. Kremeier K, Fasen L, Klaiber B, et al. Influence of visiting professor Nova Southeastern
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sional finite element analysis of stress distribu- Fracture resistance and deflection of pulpless endodontic post type (glass fiber, quartz fiber or University College of Dental Medicine, Fort
tion in composite resin cores with fiber posts of anterior teeth restored with composite or porce- gold) and luting material on push-out bond Lauderdale, Fla and has a private practice in
lain veneers. J Endod. 2010;36:153-156. strength to dentin in vitro. Dent Mater.
SO

varying diameters. Dent Mater J. 2008;27:49-55. Mexico City, Mexico. He can be reached at
5. Rosenstiel SF, Land MF, Fujimoto J. Contemporary 26. Hayashi M, Takahashi Y, Imazato S, et al. Fracture 2008;24:660-666.
resistance of pulpless teeth restored with post- 47. Akgungor G, Akkayan B. Influence of dentin bond- [email protected].
Fixed Prosthodontics. 3rd ed. St. Louis, MO:
Mosby; 2001:295. cores and crowns. Dent Mater. 2006;22:477-485. ing agents and polymerization modes on the bond
6. Torbjrner A, Karlsson S, Odman PA. Survival rate 27. Glazer B. Restoration of endodontically treated strength between translucent fiber posts and three Disclosure: Dr. Kogan is the designer and
R

and failure characteristics for two post designs. J teeth with carbon fibre postsa prospective dentin regions within a post space. J Prosthet patent owner of the PeerlessPost (SybronEndo).
Prosthet Dent. 1995;73:439-444. study. J Can Dent Assoc. 2000;66:613-618. Dent. 2006;95:368-378.
28. Schmitter M, Rammelsberg P, Gabbert O, et al. 48. Radovic I, Monticelli F, Goracci C, et al. Self-adhe-
PE

7. Martelli R. Fourth-generation intraradicular posts

for the aesthetic restoration of anterior teeth. Influence of clinical baseline findings on the sur- sive resin cements: a literature review. J Adhes Dr. Friedman maintains a private practice lim-
Pract Periodontics Aesthet Dent. 2000;12:579- vival of 2 post systems: a randomized clinical Dent. 2008;10:251-258.
trial. Int J Prosthodont. 2007;20:173-178. 49. Baldissara P, Monaco C, Valandro LF, et al.
ited to endodontics in London, Ontario,
588.
29. Ferrari M, Vichi A, Mannocci F, et al. Retrospective Retention of quartz fiber posts using different lut- Canada, and is assistant adjunct professor in
8. Milnar FJ. Aesthetic treatment of dark root syn-
drome. Dent Today. September 2010;29:74-79. study of the clinical performance of fiber posts. Am ing cements. J Dent Res. 2009;88(A, special the division of restorative dentistry at the
R

9. Anderson GC, Perdigo J, Hodges JS, et al. Ef- J Dent. 2000;13(special issue):9B-13B. issue). Abstract 976. University of Western Ontario, London,
ficiency and effectiveness of fiber post removal 30. Fazekas A, Menyhrt K, Bdi K, et al. Restoration of 50. Ferrari M, Carvalho CA, Goracci C, et al. Influence Canada. He can be reached via e-mail at
FO

using 3 techniques. Quintessence Int. root canal treated teeth using carbon fiber posts [in of luting material filler content on post cementa- [email protected].
2007;38:663-670. Hungarian]. Fogorv Sz. 1998;91:163-170. tion. J Dent Res. 2009;88:951-956.
10. Cormier CJ, Burns DR, Moon P. In vitro compari- 31. Cagidiaco MC, Radovic I, Simonetti M, et al. 51. Grande NM, Butti A, Plotino G, et al. Adapting Disclosure: Dr. Friedman reports no disclosures.
son of the fracture resistance and failure mode Clinical performance of fiber post restorations in fiber-reinforced composite root canal posts for
of fiber, ceramic, and conventional post systems endodontically treated teeth: 2-year results. Int J use in noncircular-shaped canals. Pract Proced
at various stages of restoration. J Prosthodont. Prosthodont. 2007;20:293-298. Aesthet Dent. 2006;18:593-599. Dr. de Rijk was formerly in the department of
2001;10:26-36. 32. Ferrari M, Cagidiaco MC, Grandini S, et al. Post 52. Plotino G. Grande NM, Pameijer CH, et al. Influence
placement affects survival of endodontically treat- of surface remodelling using burs on the macro
restorative dentistry at the University of
11. Frazer RQ, Kovarik RE, Chance KB, et al. Removal
ed premolars. J Dent Res. 2007;86:729-734. and micro surface morphology of anatomically Tennessee Health Science Center Memphis,
time of fiber posts versus titanium posts. Am J
Dent. 2008;21:175-178. 33. Grandini S, Goracci C, Tay FR, et al. Clinical eval- formed fibre posts. Int Endod J. 2008;41:345-355. Tenn. He is currently an associate professor of
12. Gesi A, Magnolfi S, Goracci C, et al. Comparison uation of the use of fiber posts and direct resin 53. Ferrari M, Scotti R. Fiber Posts: Characteristics restorative dentistry and chief of the biomate-
of two techniques for removing fiber posts. J restorations for endodontically treated teeth. Int and Clinical Applications. Paris, France: Masson rials Unit at the School of Dental Medicine
Endod. 2003;29:580-582. J Prosthodont. 2005;18:399-404. Publishing; 2002:94-95. East Carolina University. He can be reached at
13. Rosenstiel SF, Land MF, Fujimoto J. Contemporary 34. Cagidiaco MC, Goracci C, Garca-Godoy F, et al. 54. Iglesia-Puig MA, Arellano-Cabornero A. Fiber-rein- (252) 737-7020 or at [email protected].
Fixed Prosthodontics. 3rd ed. St. Louis, MO: Clinical studies of fiber posts: a literature review. forced post and core adapted to a previous metal
Mosby; 2001:275. Int J Prosthodont. 2008;21:328-336. ceramic crown. J Prosthet Dent. 2004;91:191-194.
Disclosure: Dr. de Rijk reports no disclosures.

MAY 2011 DENTISTRYTODAY.COM