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Today, the clinician can choose from a variety of post-and-core systems for different endodontic and restorative requirements. These systems and methods are well-documented in the literature.8-10 However, no single system provides the perfect restorative solution for every clinical circumstance, and each situation requires an individual evaluation.
Custom Cast Posts
The traditional custom-cast dowel core provides a better geometric adaptation to excessively flared or elliptical canals, and almost always requires minimum tooth structure removal.1 Custom cast post-and-cores adapt well to canals with extremely tapered canals or those with a noncircular cross section and/or irregular shape, and roots with minimal remaining coronal tooth structure.9 Patterns for custom cast posts can be formed either directly in the mouth or indirectly in the laboratory. Regardless, this method requires 2 appointment visits and a laboratory fee. Also, because it is cast in an alloy with a modulus of elasticity that can be as high as 10 times greater than natural dentin,11 this possible incompatibility can create stress concentrations in the less rigid root, resulting in post separation and failure. Additionally, the transmission of occlusal forces through the metal core can focus stresses at specific regions of the root, causing root fracture.11 Furthermore, upon aesthetic consideration, the cast metallic post can result in discoloration and shadowing of the gingiva and the cervical aspect of the tooth.
PREFABRICATED POST-AND-CORE SYSTEMS
An alternative consideration is the prefabricated post-and-core system. Prefabricated post-and-core systems are classified according to their geometry (shape and configuration) and method of retention. The methods of retention are designated as active or passive. Active posts engage the dentinal walls of the preparation upon insertion, whereas passive posts do not engage the dentin, relying instead on cement for retention.1 The basic post shapes and surface configuration are tapered, serrated; tapered, smooth-sided; tapered, threaded; parallel, serrated; parallel, smooth-sided; and parallel, threaded. While active or threaded posts are more retentive than the passive posts, the active posts create high stress during placement and increase the susceptibility of root fracture when occlusal forces are applied. Parallel-sided serrated posts are the most retentive of the passive prefabricated posts, and the tapered smooth-sided posts are the least retentive of all designs.2
Prefabricated Metal Posts
Traditional prefabricated metal posts are made of platinum-gold-palladium, brass, nickel-chromium (stainless steel), pure titanium, titanium alloys, and chromium alloys.2,4 Although stainless steel is stronger, the potential for adverse tissue responses to the nickel has motivated the use of titanium alloy.12 Also, contributing factors to root fracture such as excessive stiffness (modulus of elasticity)13 and post corrosion2 from many of these metal posts have stimulated concerns about their use.
Prefabricated Nonmetallic Posts The nonmetallic prefabricated posts have been developed as alternatives, including ceramic (white zirconium oxide) and fiber-reinforced resin posts. Zirconium oxide posts have a high flexural strength, are biocompatible, and are corrosion resistant. However, this material is difficult to cut intraorally with a diamond, and to remove from the canal for retreatment.4 The fiber-reinforced composite resin post-and-core system offers several advantages: a one appointment technique, no laboratory fees, no corrosion, negligible root fracture, no designated orifice size, increased retention resulting from surface irregularities, conserved tooth structure, and no negative effect on aesthetics.