Conservative Universal Post and Core Buildups

Conservatism has become the standard in healthcare, but especially in dentistry. Preserving as much original tooth structure as possible is paramount in endodontic and restorative treatment today.⁶ Endodontists are creating the smallest access openings possible and removing the minimal amount of internal tooth structure necessary. Ideally, a post and core should use the strongest material in as much of its composition as possible while requiring minimal removal of the root structure. This creates a dilemma for restorative dentists. Using a traditional, smaller diameter post preserves more root structure but requires a larger, weaker composite core with less surface area to bond to the post. If a larger diameter post is used to increase strength, more root structure is removed, and a ledge may be created that can increase the risk of catastrophic root fracture.

This case report describes the use of a post and sleeve system that was recently introduced to help solve the challenges posed by the minimal removal of root structure while providing maximum strength. It is comprised of a single size drill and post that has a tapered sleeve made of the same material. The sleeve is designed to slide vertically down the post into flared canals to the depth required for best fit.

A patient presented with a broken-down tooth (ie, tooth No. 28) that required root canal therapy. There was a significant loss of tooth structure; therefore, a post and core treatment was deemed necessary to support a crown (Figure 1). The patient was anesthetized, and any remaining decay was excavated. After a radiograph was acquired, evaluated, and measured, a drill was used to remove approximately two-thirds of the length of the root canal filling material (Figure 2). Another radiograph was taken to confirm that the depth achieved was correct. Next, the single adjustable post system (Splendor SAP, Angelus) was tried in first without the sleeve to determine if it was fully seated (Figure 3). Then it was tried in with the sleeve and deemed to fit well (Figure 4).

This post is is among the narrowest available (0.65 mm at the apical tip, 1.0 mm at the coronal end), allowing it to fit into auxiliary canals. A sleeve is included that can be utilized, when necessary, to customize it to fit flared or overprepared canals. The sleeve significantly reduces the volume of cement required to fill the coronal area of the pulp chamber and is much stronger than composite resin, so the result is a conservative, single-visit post and core treatment that is less prone to fracture.

Following try-in, the post and sleeve were cleaned (ZirClean^®, BISCO) and then thoroughly rinsed and dried. A surface primer (Z-PRIME^™ Plus, BISCO) was applied to both components and allowed to dry for 2 minutes (Figure 5). Next, the root canal was acid etched (Uni-Etch^® w/BAC, BISCO) for 5 seconds, washed, and partially dried using air and paper points. Chlorohexidine was then applied to the root canal for 30 seconds. After the excess moisture was removed using air and paper points, several coats of a self-curing universal dentin bonding agent (Universal Primer^™, BISCO) were applied with a slender brush and rubbed for 30 seconds. These surfaces were then dried for 10 seconds with dry air. Using a self-curing adhesive primer helps to ensure that the bonding agent will cure completely when placed 6- to 12-mm deep into a canal where a curing light cannot effectively reach.

A dual-cure resin cement/buildup material (Core-Flo^™ DC Lite, BISCO) was mixed and first placed on the post and sleeve. Next, a small amount of the cement was placed into the canal, and the post and sleeve were quickly inserted. The post was pushed firmly down into the canal and held while the sleeve was pushed down using a pair of cotton pliers. Additional resin was then placed to fill in and build up to the desired level, and a curing light was held over the occlusal aspect for 40 seconds (Figure 6). After the area was isolated from moisture and allowed to completely set for 3 minutes, a radiograph was taken of the post and sleeve with the buildup (Figure 7), a crown preparation was performed (Figure 8), and a provisional was fabricated for the patient (Figure 9). He returned 3 weeks later for the final crown to be seated (Figure 10).

With proper diagnosis, excellent root canal treatment, conservation of tooth structure, adequate substructure, a well-fitting crown, and careful attention to functional occlusion, we can provide an effective way to save teeth.

Daniel H. Ward, DDS
Fellow
Academy of General Dentistry
Fellow
American Society for Dental Aesthetics
Private Practice
Columbus, Ohio

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