The following is a guest post by Mark Wilhelm, DMD MSD. If you are interested in guest posting for Dental Heroes, please sign up here .
As restoring doctors, we know enough about the risk of utilizing fractured anterior teeth for post retained restorations. Examining a past issue of Inside Dentistry , I ran across an article covering “Post and Core Foundations for Esthetic Restorations”. The photos that were included in the story showed a central incisor fractured without a ferrule and the labial down to the gingival sulcus.
Somehow the word “Esthetic Restorations” is supposed to throw you into forgetting the basics. The author states that “there was very little coronal tooth structure remaining – the Flexi-Flange® Prefabricated Post System would be ideal for this clinical situation. A metal post was selected for this due to lack of remaining tooth structure the Flexi-flange helps dissipate occlusal forces to eliminate intraradicular stress fractures. The flange portion of the post countersinks completely into tooth structure to maximize fracture resistance of the root and post by safely dispersing occlusal forces over a broad area.”
How many times do we have to listen to this bologna? Anterior teeth flex under use. The key is how much tooth structure is remaining and what the occlusal status is. The post will do nothing to strengthen to the tooth. If there is only a root stump left then all the force of occlusal loading will be on the post/root interface regardless of design. IT WILL FAIL. My number one clinical reason to place a single tooth implant is because of a recently failed post and crown.
Our goal in dentistry is to serve our patients with a crystal ball that will attempt to predict the future and allow us to make clinical decisions that keep the most teeth for the longest period of time. Our patients trust us. What do we tell them when they just plunked down good money for a root canal, post and crown and it fails a year later? You have to ask yourself: why did the original tooth fracture? Do you think that what you do to a wounded tooth will restore it to a condition that is better than it was before it broke? I think not.
An implant is better than a bad tooth. If there is not enough tooth to support a crown without a post, then don’t put a post in it. The intent of a post is only to support a core if there is missing clinical crown, not to support a crown.
Do you agree with Dr. Wilhelm? Let us know in a comment below.