Fixed Prosthodontics

3rd Lecture

PRINCIPLES OF TOOTH PREPARATION

Many of the principles of tooth preparation apply equally to the
preparation of endodontically treated teeth, although certain additional
concepts must be understood to avoid failure.

Fig. 3-1: A, It is preferable to maintain as much

coronal tooth structure as possible, provided it is
sound and of reasonable strength. B, Extensive caries
has resulted in the loss of all coronal tooth structure.
This is less desirable than the situation in A, because
greater forces are transmitted to the root.

In a maxillary central incisor prepared for a post-and-core, six features of

successful design are identified (Fig. 3-2):
1. Adequate apical seal.
2. Minimum canal enlargement (no undercuts remaining).
3. Adequate post length.
4. Positive horizontal stop (to minimize wedging).
5. Vertical wall to prevent rotation (similar to a box).
6. Extension of the final restoration margin onto sound tooth structure.

Fig. 3-3: Use of a prefabricated post entails enlarging the

canal one or two file sizes to obtain a good fit at a
predetermined depth.
A, Incorrect; the prefabricated post is too narrow.
B, Incorrect; the prefabricated post does not extend to the
apical seal.
C, Correct; the prefabricated post is fitted by enlarging the
canal slightly.

Fig. 3-4: Extending a preparation apically creates a

ferrule and helps prevents fracture of an
endodontically treated tooth during function.
A, Prepared with a ferrule (arrows)
B, Prepared without a ferrule.

-1-
Fixed Prosthodontics
3rd Lecture

CONSERVATION OF TOOTH STRUCTURE

Preparation of the Canal:
When creating post space (Fig. 3-2), great care must be used to remove only
minimal tooth structure from the canal. Excessive enlargement can perforate
or weaken the root, which then may split during cementation of the post or
subsequent function.
The thickness of the remaining dentin is the prime variable in fracture
resistance of the root. Experimental impact testing of teeth with cemented
posts of different diameters' showed that teeth with a thicker (1.8 mm) post
fractured more easily than those with a thinner (1.3 mm) one.
The root canal should be enlarged only enough to enable the post to fit
accurately yet passively while ensuring strength and retention. Along the
length of the post space, enlargement rarely needs to exceed what would
have been accomplished with one or two additional file sizes beyond the
largest size used for endodontic treatment. Because of the more coronal
position of the post space, a much larger file must be used to accomplish this
(Fig. 3-3).

Preparation of Coronal Tissue

Endodontically treated teeth often have lost much coronal tooth structure as
a result of caries, previously placed restorations or in preparation of the
endodontic access cavity. However, if a cast core is to be used, further
reduction is needed to accommodate a complete crown and to remove
undercuts from the chamber and internal walls. This may leave very little
coronal dentin. Every effort should be made to save as much of the coronal
tooth structure as possible, because this helps reduce stress concentrations at
the gingival margin (Fig. 3-1). Extension of the axial wall of the crown
apical to the missing tooth structure provides what is known as a ferrule,
which is defined as a metal band or ring used to fit the root or crown of a
tooth, as opposed to a crown that just encircle core material (fig. 3-4).

RETENTION FORM
Circular parallel post systems are only effective in the
most apical portion of the post space because the
majority of prepared post spaces demonstrate
considerable flare in the occlusal half. Similarly, when
the root canal is elliptical, a parallel-sided post will
not be effective unless the canal is considerably
enlarged, which would significantly weaken the root
unnecessarily (Fig. 3-5).
Fig. 3-5: The use of a parallel-sided
post in a tapered canal requires
considerable enlargement of the
post space, which can weaken the
root significantly

-2-
Fixed Prosthodontics
3rd Lecture

Fig. 3-6: Effect of the depth of embedding a post on its retentive capacity.

Post Length
Studies have shown that as post length increases, so does retention.
However, the relationship is not necessarily linear (Fig. 3-6). A post that is
too short will fail (Fig. 3-7), whereas one that is too long may damage the
seal of the root canal fill or risk root perforation if the apical third is curved
or tapered (Fig. 3-8).

Fig. 3-7: Faciolingual longitudinal sections through a maxillary central incisor.

A, With a post of the correct length, a force (F) applied near the incisal edge of the crown will generate
a resultant couple (R). B, When the post is too short, this couple will be greater (R'), leading to the
increased possibility of root fracture.

Fig. 3-8: A, Correct post length. B, The post is too short;

the consequences are inadequate retention and increased
risk of root fracture. C, The post is too long, jeopardizing
the apical seal.

-3-
Fixed Prosthodontics
3rd Lecture

Fig. 3-9: Effect of horizontal grooving on

the retention of tapered posts.

Post Surface Texture

A serrated or roughened post is more
retentive than a smooth one, and
controlled grooving of the post and root
canal (Fig. 3-9) considerably increases
the retention of a tapered post.

RESISTANCE

Fig. 3-10: Cast cores for posterior teeth can be made in interlocking sections, with each section
having its own path of withdrawal.

-4-
Fixed Prosthodontics
3rd Lecture

Fig. 3-11: Single-piece castings can be made by selecting the larger-diameter canal and
extending a second post for a limited distance into the smaller canal. D to F, Post-and-core
provided for a maxillary first premolar by the indirect technique.

Fig. 3-12: Rotational resistance in an extensively damaged

tooth can be obtained by preparing a small groove in the root
canal. This must be in the path of placement of the post-and-core.

PROCEDURES
Tooth preparation for endodontically treated teeth can be considered a
three-stage operation:
1. Removal of the root canal filling material to the appropriate depth.
2. Enlargement of the canal.
3. Preparation of the coronal tooth structure.

-5-
Fixed Prosthodontics
3rd Lecture

Fig. 3-13: Gutta-percha can be removed from the canal with a heated endodontic plugger (A
and B), a non-end-cutting bur (C) (e.g., a Gates Glidden drill), or a ParaPost drill (D) (with a
rubber stop to ensure accuracy of the preparation depth).

REMOVAL OF THE ENDODONTIC FILLING MATERIAL

1. Before removing gutta-percha, calculate the appropriate length of the
post. It should be adequate for retention and resistance but not long
enough to weaken the apical seal. As a guide, make the post length
equal to the height of the anatomic crown (or two-thirds the length of
the root), but leave 5 mm of apical gutta-percha. On short teeth, it
will not be possible to meet both these restrictions, and a compromise
must be made.
An absolute minimum of 3 mm of apical fill is needed. If this cannot
be achieved without having a very short post, the tooth's prognosis is
seriously impaired.
2. Avoid the apical 5 mm if possible. Curvatures and lateral canals may
be found in this segment. If the working length of the root canal is
known, the length of the post space can be easily determined.
Therefore, the incisal or occlusal reference point must not be lost as a
result of premature removal of coronal tooth structure.
3. To prevent aspiration of an endodontic instrument, apply a rubber
dam before preparing the post space.
4. Select an endodontic condenser large enough to hold heat well but not
so large that it binds against the canal walls.
5. Mark it at the appropriate length (normally endodontic working
length minus 5 mm), heat it, and place it in the canal to soften the
gutta-percha.
6. If the gutta-percha is old and has lost its thermoplasticity, use a rotary
instrument, making sure that it follows the gutta-percha and does not
engage dentin (this will cause a root perforation).

-6-
Fixed Prosthodontics
3rd Lecture
For this reason, high-speed instruments and conventional burs are
contraindicated. Special post preparation instruments are available
(Fig. 3-14). Peeso -Reamers and Gates Glidden drills are often used
for this purpose.
7. If using a rotary instrument, choose it to be slightly narrower than the
canal.
8. Make sure the instrument follows the center of the gutta-percha and
does not cut dentin. Often, only a part of the root canal filling needs
to be removed with a rotary instrument, and the remainder can be
removed with the heated condenser. A rotary instrument should not
be used immediately after obturation, because it may disturb the
apical seal.
9. When the gutta-percha has been removed to the appropriate depth,
shape the canal as needed. This can be accomplished by using an
endodontic hand instrument or a low-speed drill.

Fig. 3-14: Commonly used instruments for gutta-percha removal and canal enlargement. A,
Endodontic pluggers, two sizes of Peeso-Reamers with corresponding twist drills and
endodontic file. Note attached floss as a safety precaution. B, The ParaPost twist drill
corresponds in size to an aluminum post used to fabricate provisionals, a plastic post for
patterns, and a stainless-steel or titanium post.

ENLARGEMENT OF THE CANAL

Before enlargement of the canal, the type of post system to be used for
fabrication of the post-and core must be chosen.
The advantages and disadvantages of different post types are summarized in
the attached table. Because no system has universal application, being
familiar with more than one technique is a significant advantage. A wide
range of prefabricated posts are available. They come in many shapes and
sizes (Figs. 3-15).

Fig. 3-15: Classification of prefabricated posts.

A, Tapered, smooth-sided posts.
B, Tapered, serrated posts.
C, Tapered, threaded posts.
D, Parallel, smooth-sided posts.
E, Parallel, serrated posts.
F, Parallel, threaded posts.

-7-