Question: How deep should we place a post into a root canal?
Can anybody discuss on the topic “how deep should we place a post into a root canal”?
Salvatore Sauro: Massimo Giovarruscio one of greatest experts on this 😉
Sergio Hernández: https://www.aae.org/…/endodontics…/ss04ecfeforweb.pdf
Liviu Steier: Are you kidding? Are you really presenting data from 2004??????
Menia Kigka: follow
Sergio Hernández:
Menia Kigka: cast post or fiber glass one..?
Antonio Scarlatella: Fiber glass
Walter Zenobi: Can anybody discuss on the topic “Was Today Really Necessary?” No post, no crown??? Master David Gerdolle…
Liviu Steier: The indication for post is exclusively reserved for catastrophically destroyed teeth at an equigingival level.
Walter Zenobi: Ok, great … unfortunately it is not always so in daily clinical activities of many colleagues
Menia Kigka: since it’s supposed to rely on adhesion mostly, it shouldn’t go so deep. But then adhesion in the root canal dentin can be compromised.. I usually go slightly longer than the crown would be. That’s an interesting topic!!!
مكسيم نوفل: if to put focus on few things:1- make sure a post is what u really need, if not, then dont.2- use fiber posts.3- dont trust thin posts but preserve root structure 4- at least half of the canal should be used, less than 4mm deep posts ar generally useless, but leave 4mm of gutta b.5- bond it, dont cement it.6- use the largest canals, leave the thin ones alone. 7- if have to use active posts, threaded or screws, driving it should be smooth, not forceful, and not loose. if u feel it tightens up too early, stop and remove it.8- and please please please, do some math, dont leave a gab between gutta b. and the post. consider crown length too.9- and last, posts are to retain core, they dont do miracles.they are additional, and not basic crown retainer.
Nawras Mostafa: Totally agree specially about the real indications of the post
Hala Bawab: Consider crown length and furrel depth .. Beside what مكسيم نوفل said..
مكسيم نوفل: i respect “mechanical” science of the subject, but from what i see in daily practice, dentists seem to skip the scientific talk and look for short notes.if we to do it right, many calculations should be considered in the math, but i dont think many dentists would do it.but yes, it is important. 🙂
Stefano Daniele: In my opinion it does not so important, I mean that could remain almost 5.0 mm of apical gutta to garantee apical sealing. In the middle and apical third of canal the adhesion to dentin is very bad. It’ important to me not compromise the apical sealing. My humble opinion.
Lim Foong Fee: At least 6 mm of root fill.
Ali Al-Qrimli: Lovely disscussion
Liviu Steier: It is worth understanding the purpose of the post: to anchor the core build up. The less tooth structure one comprises the longer the survival rate. A long post may be able to transport micro movements into the compromised root. Retention of the post in the root and retention of the core build up should be reached via geometry of the post and the mechanical fitting into the canal lumen. The cement will only compliment the fitting. Understanding and considering the above one can conclude that the early theoretical requirements of a post length in the canal are to be disconsidered! Hope this make sense!
Antonio Scarlatella: Ok but how many mm into The root for to obtain retention?
Antonio Scarlatella: Ok it is always variable… But is There a minimal lenght for to obtain post ritention?
Antonio Scarlatella: Thanks
Andrea Fabianelli: Probably we don’t need this help…;)
Liviu Steier: Antonio Scarlatella giving you this answer makes it all dogmatic again!
Liviu Steier: Once again one has to consider several decision criteria to individually valuate the length of the post in the canal. Some examples: size of canal, position of the tooth in the jaw, number of roots, strength of the remaining dentin, level of hard tissue destruction, occlusal forces, materials used, type of restoration to follow,…..
Liviu Steier: Time has come to allow us to move away from dogmas!
Stefano Daniele: Great observations Liviu.
Liviu Steier: Thank you my friend! Much appreciated!
Matteo Prencipe: http://www.sciencedirect.com/…/pii/S1121417114000090Andrea Polesel
Restoration of the endodontically treated posterior tooth
sciencedirect.com
Ljiljana Milic Jankovic: Min half of length ideal two third!
Ljiljana Milic Jankovic: Every time we have to follow morfology off course
Maria Henry: Following
Ljiljana Milic Jankovic: Or respect-enough but minimal invasive !
John Comisi: But if the material used to “bond” the post provides too much “stiffness” to the post, won’t that effect the short and long term results?
Andrea Fabianelli: I think that the question is …why a post in a case like this? Anyway there is an article ( I have to go and look for) reporting no difference between 5 and 10mm…Bruillaguet and Goracci pointed out how weak is adhesion in the channel environment. Of course, speaking about seal, literature reports at least 4 mm of gutta apical seal…but again..is it worth? Retention is related to all dentin…radicolar and coronal (mostly coronal) so a post in a posterior tooth is basically unuseful if a cuspal coverage is applied
Analucia Philippi: Totally agree. Although, maybe he means there’s no coronal remanecent…
Andrea Fabianelli: If this is the situation…we are in trouble..post or no post…;)
Analucia Philippi: I only place posts when there’s no available chamber. If there’s a chamber, no need.
Andrea Fabianelli: I agree..but if there is no chamber..again we are in trouble. I place post routinely only in anterior region and in heavily damaged premolars
Zvonimir Kunosic: In the era of adhesion do we actually need posts? Especially in posterior region where most of the functional forces are compressive. For anteriors, where shear forces are present, I would use a post for stiffening the adhesive interface.
Rogerio Marcondes: as my mentor Pascal says everytime.. No Post and No crown
Salvatore Sauro: Thanks a lot Massimo Giovarruscio!!!!!
Massimo Giovarruscio: This is what I do clinically
Liviu Steier: The examination of this situation leads to the following decision making process: retention within the canal was possible only at the expense of post length. The question one has to ask himself is in how far is/was the evaluation adequate or not. My individual decision based upon the x-ray analysis (questionable decision making protocol!!!) is that I would have followed a different treatment approach.
Massimo Giovarruscio:
Shareef Al-Bayati: F
Ljiljana Milic Jankovic: This post only give mechanical rete tion and now ,we have to best clean canal of sealer and make choice for best athesive cement!
Ljiljana Milic Jankovic: This post look like common without anything for mechanical retention at the post,every time is better combination of retention for safety.
Andrea Fabianelli: Post doesn t even see The tooth…adhesive does
Andrea Polesel: If a post is really mandatory, we have not to put it closer than 4 mm to the apex: this is the literature 😉 thanks Matteo!
Liviu Steier: Literature? Have you ever performed a systematic review of the literature regarding this question? If so what were your inclusion / exclusion criteria?
Andrea Polesel: No. I am a clinician. If you did it, I appreciate your work 😊 thanks
Liviu Steier: We are currently performing systematic reviews of systematic reviews….. One similar paper in underway to be reviewed. Abbas where are you? As a consequence the answer “…this is literature…” is scientifically questionable and misleading. Sorry! It is not intention to be rude! It is a scientific debate in favor of our patients!
Andrea Polesel: It is very close to my “common sense” 😊
Andrea Polesel: A very simple anatomic knowledge: in the last 4 mm it is very high the number of lateral canals. It is better not to touch the guttapercha in this part of the canal 😊 I like to discuss about this topic ❤️
Matteo Prencipe: You’re welcome Andrea Polesel 👍
Andrea Polesel: Matteo, happy to be part of this discussion… But is it finished 😳
Alaa H Ibrahem: Ssaf Mmoa
Ljiljana Milic Jankovic: Next time!
Hamza Nasrat: This is ideal post
John Comisi: Out of the mouth and in an acrylic block. Now why didn’t I think of that.
Luis E Occelli: Post space preparation. Knowing the rootanatomy of different teeth is important beforeattempting to prepare any canal space for postinstallation. For instance, clinicians must beaware that root diameter may differ in the faciallingualand mesiodistal dimensions. To determinethe appropriate post length and width to avoidroot perforation, clinicians must consider conditionssuch as root taper, proximal root invaginations,root curvatures and angle of the crown tothe root during the mechanical preparation of apost space. Gutmann40 gave a good review ofanatomical and biological considerations inrestoring ET teeth.Dentists often use mechanical preparationtechniques for post spaces because it is faster.Mechanical preparation is associated with ahigher risk of root perforation and may disturbthe apical seal. The thermal method of removinggutta-percha using heat pluggers is safer butmore time-consuming. When mechanical preparationis preferred, it has been established thatGates-Glidden drills and P-type reamers used onlow speed are the safest instruments.41 Use of oneof these instruments should precede the use ofany post drill that comes with the prefabricatedpost kit. A combination of removinggutta-percha by heat pluggers followedby the post drill should beconsidered by inexperienced operatorsto minimize the risk ofperforation.Post length. Many authors haveoffered guidelines for determiningthe desired post length. It is not difficultto understand that the longerthe post in the canal, the moreretentive it is. However, increasedpost length also increases risk of fracture and perforationof the remaining root.42 It generally isaccepted that the apical 3 to 6 mm of guttaperchamust be preserved to maintain the apicalseal.43-45 Acceptable guidelines for determining thepost length include the following:dthe post length should be equal to the clinicalcrown length46,47;dthe post length should be equal to one-half totwo-thirds of the length of the remaining root4,48;dthe post should extend to one-half the length ofthe root that is supported by bone.49As I stated previously, root anatomy variesfrom tooth to tooth and even within the sametooth in different patients. Clinicians must considerthese variations along with the guidelines.Each clinical situation is unique, so the preparationof the post space must be evaluated carefullyand planned for accordingly.
Luis E Occelli: A review of themanagement ofendodontically…See more
Luis E Occelli: JADA, Vol. 136 www.ada.org/goto/jada May 2005 611
Journal of the American Dental Association (JADA)
ada.org