In 1994 when I first decided to use a Composipost, retrievability was my main concern. My patient’s lower left, first bicuspid had an old direct pulp cap that abscessed. I performed endodontics on the tooth but the pain did not subside. Worried about the patient’s history of severe allergies and that there might be something terribly pathologic in the area, I referred her to an oral surgeon. He told me to remove the endodontic condensation, let the tooth drain for a month and if the area was symptom free to reseal it. He also prescribed some very strong antibiotics. This was accomplished and the tooth was and remains asymptomatic.
The next step was to restore the tooth with a post, a core and a crown. Considering the complications that arose when I previously attempted endodontics on this patient, the last thing I wanted to place was a difficult to retrieve metallic post. The Composipost had been introduced to North America a bit earlier and its easily removable properties swayed my decision. The post was placed; a core build-up made, and an Empress crown was placed. It remains secure, and the easily removable post is a bit of insurance in case the tooth acts up again. Currently, metal posts are removable in many situations using special ultrasonic instrumentation and perseverance. I still prefer the Composipost because I find they give good results in a safe and user-friendly manner. (Figs. 1 & 2)
OTHER BENEFITS OF COMPOSIPOSTS ARE
Non-corrodable in oral fluids (many metal posts are gold plated brass that will corrode once the plated surface is damaged).
Properties very similar to dentin and when bonded in place it is like having a solid block of dentine, which should strengthen the roots.
Bonds to tooth and bondable crown.
If breakage occurs, the root is not usually damaged and the case can be rescued.1
Has 2-3 times the fatigue resistance of metal posts.
User friendly reduced chair time.
Biocompatible.
Can be cut like a composite.
Minimal dentine removal.
Backed by over 25 published articles, mainly from Europe.
Furthermore other studies are of interest:
A retrospective study of 236 patients with teeth restored by Carbon-fiber-reinforced epoxy resins by Fredriksson, Astback, Pamenius and Arvidson,2 concluded that the Carbon fiber post offered a resilient, highly retentive method with uninterrupted bonding between the tooth through the post and the core. The Composipost system seems to be a promising alternative to conventional cast metallic posts.
Their study showed that of 236 treated:
5 teeth (2%) had to be extracted for other reasons
No post or crown came loose
No fractures of any composipost
No post perforations
A similar study with metallic posts had 8.3% failure (Torbijoner et al).
Another study by Dean JP, Jeansonne, Sarkar N J3 Endod (Dec; 24(12): 807-10) found no root fracture in carbon posts but there were five fractures in each of the parallel and tapered post groups.
Although I am in general agreement with the article in JPD by Martinez-Insua A, da Silva L, Rilo B, Sanatana U. Comparison of the fracture resistance’s of pulpless teeth restored with a cast post and core or carbon-fiber post with a composite core,4 I would point out that their findings also show that: post and cores should be strong but fail before root damage; cast-posts allow dangerously high fracture-threshold values; and composipost and composite cores failed at acceptably high loads, yet before root fracture.
Examples of cases where the Composipost can be used:
a) This patient presented with a broken metal post. By using a high-speed bur, and with extreme caution this broken metal post was removed without perforating the canal. The canal was then prepared for a Composipost. If a future problem occurs, the Composipost can be easily removed without damage to the remaining root structure. (Figs. A-E)
b) Saving a crown and partial.5 In this case a crown that used to hold a partial with a semiprecision attachment was loose. Upon removal of the crown extensive decay was found. It was decided that for adequate retention, this tooth required endodontics and Composiposts. The crown fit the margins properly so it was a relatively simple repositioning of the parts and core buildup with cementation via bonded Bis Fil II.
This saved an otherwise serviceable partial. (Figs. 3-6)
PREPARATION AND CEMENTATION OF COMPOSIPOSTS AND AESTHETIC POSTS:
1. Select two nippled peeso reamers6 one smaller than the last file used (lessens chance of perforation because of the safe end and the fact that it is in gutta percha only) and one slightly larger and prepare the tooth to the desired post length. Increase reamer sizes until all the gutta percha both horizontally and vertically to the desired length is removed. (Fig. 7)
2. Select a post closest in diameter to the last reamer used.7
3. Finish with the special final prep drill from the kit of the post selected. Prepare the final canal shape. This method should allow for the largest post for the tooth with the least dentin removal. (Fig. 8)
4. Cut retention grooves into the prepared canal wall for added retention. (Groover from FILPOST, Dental USA).8,9 Into thicker parts of canal–usually facially and lingually. (Fig. 9)
5. Clean out the canal with alcohol in a pipette (JS Pipettes) and alcohol on a brush (Peeso Brush-Premier Dental Products). This will clean out any traces of eugenol that may hinder bonding. This will also make the treated surface easier to wet,10,11 wash and dry. This step can be eliminated if etching is used. (Figs. 10 & 11)
6. Etch canal for 15 seconds with 32-37% phosphoric acid. (Fig. 12)
7. Wash the canal well, even using the pipette to introduce water into the deeper parts of the prepared canal. (Fig. 13)
8. Dry and apply Diamond Primer A&B. Dry.
9. Apply Diamond bond + its catalyst into the canal and on the post and thin. (Fig. 14)
10. Mix Diamond Link (Biodent Montreal) and inject into canal using a needle tipped CR syringe.
11. Insert post (Biodent Montreal) with a slightly vibrating motion until fully seated. Hold in place and remove excess cement with a bend-a-brush.
12. Still holding post in place light activate 5 sec. on each side to keep the post in place while the cement dual cures in about 5 min.
13. Build up the core with Diamond lite or Diamond Crown composite. Remove any excess cone with a high-speed diamond.
14. Tooth can then be prepared for a crown if required. (Fig. 15)
CONCLUSION
As seen in the examples presented, these fiber posts offer a safe, retrievable, simple way to trouble shoot many situations where a post might be needed.
The newer Aestheti-Post (Quartz Fibers) — all white, also lessen any dark shine through that the original black carbon posts might have shown.
It can be anticipated that many more ideas favoring this type of post will on the market in the near future.OH
Dr. Marotta maintains a private practice in Welland, ON.
Oral Health welcomes this original article.
REFERENCES
1.Isidor F. Odman P Brondum K Intermittant loading of teeth restored using prefabricated carbon fiber posts Int J Prosthodont 1996; 9:131-6
2.Fredriksson, Astback, Pamenius and Arvidson—-JPD Aug 1998 Vol.80 Issue 2: 151-157
3.Dean JP, Jeansonne, Sarkar N J Endod (Dec; 24(12): 807-10
4.Martinez-Insua A, da Silva L, Rilo B Sanatana U. Comparison of the fracture resistances of pulpless teeth restored with a cast post and core or carbon fiber post with a composite core. JPD 1998 Nov; 80(5): 527-32
5.Marotta, John D. Salvaging an Existing Bridge. Oral Health. September 1987; Vol.77/No 9:75-78
6.Marotta John D, Simplified Post and Core Technique.Oral Health 1985 June; Vol. 75(No6):
7.Seibly, W.S., Nemetz, H., Passive Post Placement Technique: Description of a Technique; Oral Health 1994 April pg 9-16
8.Nemetz. H. Personal conversation before 1993 then Oral Health Retention of posts cemented with Resin-Based Luting Agents Tjan Anthony, Nemetz Harold Oral Health 1993 November; pg 9-14
9.Tjan, A, Nemetz, H., Effect of corrugated Post-spaces and retention of Posts. J.Dental Research 1993; 72:216:ABSTS. 898
10.Nemetz H paper presented at IADR meeting Chicago
11.Tjan AH-private conversation before a published article 1992 Tjan AH, Nemetz H. Effect of eugenol-containing endodontic sealer on retention of prefabricated posts luted with adhesive composite resin cement. Quintessence Int 1992 Dec; 23(12): 839-44
