R E S TO R AT I VR

E EDSE TN O
T R
I SATTR IY V E D E N T I S T R Y

Non-metal Post Systems

DOMINIC A. STEWARDSON

core upon which a restoration can

Abstract: For many years metals, whether cast or prefabricated, have been be placed. The important factors
exclusively used to construct posts as foundations for indirect restorations. determining retention of posts have
Developments in composite and ceramic materials have resulted in the introduction of
been extensively investigated.9
metal-free post systems as alternatives. This article provides an overview of the systems
currently available, gives guidance on their use, and discusses some of the principles
These are length, taper, surface
underlying the clinical performance of posts. configuration, surface treatment and
the material used for luting.
Dent Update 2001; 28: 326-336

Clinical Relevance: Before introducing new post systems into clinical practice, POST FAILURE
dentists need to be able to understand the scientific principles involved in their clinical
performance in order to evaluate the claimed advantages of these alternatives to
It is acknowledged that posts can
established systems. weaken roots and lead to root fracture.
The important factors predisposing to
root fracture are:

inadequate thickness of dentine;7,8

use of tapered posts;10

use of threaded posts;11

short post length;12
T he construction of posts (or
dowels) has been used as a means
of providing anchorage for restorations
the aesthetic potential of restorative
materials.
failure to create a ferrule of
adequate length and taper.13
for over 250 years: in 1728 the French
dentist Pierre Fauchard was placing FUNCTIONS OF POSTS Some studies have suggested that
metal screw posts in the roots of teeth Posts have been used mainly for two post crowns have a high failure rate;14,15
to retain prostheses.1 Traditionally, due reasons: however, Sorensen and Martinoff’s
to their suitable physical properties and study16 of post-restored, endodontically
facility for being cast or machined into 1. Reinforcement. It was once treated teeth showed success rates of
precise forms, metals have been used to considered that endodontically 87.3% for tapered cast posts and cores,
fabricate the post and/or core. In recent treated teeth were weak and that it and 100% success for parallel-sided
years, however, non-metal alternatives was necessary to place a post into posts when the length of the post
for posts have been introduced the root to strengthen it, and exceeded the length of the crown.
following developments in ceramics and research appeared to support this.2,3 These teeth had been restored for
polymers for industrial and biomaterial However, other studies contradicted between 1 and 25 years. Weine et al17
use. Other factors leading to their this concept,4,5 and it is currently reported on his use of cast-tapered
introduction into dentistry have been accepted that post placement can posts, which after 10 years recorded
the desire by some patients to avoid the contribute to tooth fracture.6 The only five failures due to root fracture or
use of metals in the mouth, advances in amount of dentine remaining after restorative causes in 138 teeth. It is
adhesive materials, and improvements in endodontic treatment or caries likely therefore that failure is as much
removal may be a significant factor influenced by the skill of the operator
in determining the likelihood of and technician15 as it is by design
Dominic A. Stewardson, BDS, FDS RCPS, Clinical tooth fracture.7,8 features, and this should be borne in
Lecturer, Conservative Dentistry, University of 2. Retention. The main purpose of a mind when assessing the success rates
Birmingham. for new systems.
post is to provide anchorage for a

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ADVANTAGES OF METAL than the metal post group. carbon-fibre posts have been judged to
POST SYSTEMS be biocompatible;30,31 however, this does
Metal post systems have a number of not necessarily apply to the dentine
advantages: Aesthetics bonding systems or resin-based luting
A metal post alters the transmission of cements.
light through the tooth, and may show
History through the root.23 This effect will be
Metal posts have a well established more apparent where the gingival tissues POST TYPES
record of successful clinical service. are thin. If a non-precious post has been The metal-free alternatives currently
High success rates have been reported placed, corrosion products may pass into available can be broadly divided into
from retrospective studies over periods the root, discolouring it.24 Where all- either composite materials or ceramics.
of time that have not yet been matched ceramic restorations are used, a metal
by non-metal systems.17,18 core will alter the optical properties of the
overlying restoration.25 A number of Composites
techniques have been described to mask Composite materials are composed of
Adaptability the metal core, all of which involve fibres of carbon or silica surrounded by a
Cast posts with integral cast cores can further technical steps, and varying matrix of polymer resin, usually an epoxy
compensate for disparities between the degrees of success.26 However, masking resin. The philosophy behind the use of
angulation of the root and the planned the core alone will not alter root these materials lies in the belief that a
crown. discoloration. post should mimic the dentine of the root
in its physical properties, distribute the
stresses imposed on the restored tooth in
Core Retention Post Removal a more favourable way, and thereby
Cast posts with cores do not have the All teeth to be restored with posts should reduce the incidence of root fracture. In
potential for separation or breakdown have been endodontically treated. Should addition, if the material of the post is
that may occur between prefabricated the endodontic treatment fail, an slightly weaker than the root containing
posts and their cores. Stud attachments orthograde approach is considered to it, then the post will fracture preferentially
may more readily be joined to cast yield a higher success rate than and the root may then be re-restored.
posts. apicectomy and retrograde filling alone.27 While it may be beneficial for the post to
Removal of a long metal post to permit match the flexural modulus of the dentine,
this can be difficult, if not impossible, and it would appear to be equally important
Strength may result in root fracture. for the luting material at the interface of
Cast metals have greater strength in thin these materials to be able to flex
section than the composite adjacent to harmoniously.
fibre posts. This allows the production Biocompatibility
of ferrules, or diaphragms. Non-precious metals show corrosion Carbon-Fibre Posts
within the root. Using amalgam as a core A number of such posts are available
in combination with a prefabricated post currently: these are discussed below.
DISADVANTAGES OF METAL may set up galvanic currents and Composipost (R.T.D. France: UK source
POST SYSTEMS promote further corrosion. The corrosion Dental 21, Boreham, Essex). This system
However, these systems also have their products can pass through the dentine of was introduced in 1990 following
drawbacks: the root28 and have also been implicated research undertaken by Duret and
as a cause of root fracture.29 Ceramic and associates in France.32 Figure 1 shows

Root Fracture
The incidence of root fracture may be
reduced19,20 or may occur in a more a b
damaging manner21,22 when fibre rather
than metal posts are placed. In a
retrospective 4-year clinical study
comparing teeth restored using either
cast metal posts and cores or a carbon-
fibre system,19 the teeth with metal posts
suffered root fractures in 9% of cases
whilst the fibre post group had none and Figure 1. An early design of Composipost, being used with a composite core.
overall were significantly more successful

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differ from the Composipost in that

bundles of fibres, which are 6 µm in
diameter, are braided together within the
epoxy matrix. Fibre content is 65%. The
manufacturers claim that this
arrangement gives increased resistance
to bending and torsion compared with a
parallel fibre arrangement. The posts are
parallel-sided with a 3 mm conical tip.
Figure 2. Composipost kit with posts and drills. Three diameters (1.2 mm, 1.35 mm and Figure 4. Snowpost silica-fibre post system.
1.5 mm) are produced, with a single bur
for each size (Figure 3). These burs are
an early design of the Composipost, triangular in cross-section with no colleagues at Lyon,33 the Snowpost is
which included mechanical retention cutting flutes. The post space should be composed of 60% longitudinally
features. The current posts are smooth- pre-enlarged to the full depth before arranged silica zirconium glass fibres in
sided. They are composed of 8 µm completing the preparation with the an epoxy resin matrix. The surface is
pretensed carbon fibres arranged supplied burs. treated with silane to enhance bonding
longitudinally within an epoxy resin Mirafit Carbon (Hager Werken, with resin cements. Its shape is
matrix and make up 64% by volume. The Germany: UK source Glover Dental cylindrical, with a 3° tapered apex. Four
bundles are produced industrially and Supplies, Shrewsbury, Shropshire). This diameters – 1 mm, 1.2 mm, 1.4 mm and 1.6
are then machined to the shape and system appears identical to the mm – are contained in the complete kit,
dimensions shown in Figure 2. The Carbonite system in its construction, together with matching burs. The
posts were originally radiolucent, but dimensions and presentation. It also is tapered end is 4–6 mm long (Figure 4).
are now advertised as being radio- supplied with triangular cross-section ParaPost Fiber White (Coltene/
opaque. An initial access instrument is burs for post space preparation. Whaledent, Burgess Hill, West Sussex).
supplied, together with two burs, to Designed to complement and extend the
produce the shape of the two parallel- Silica-Fibre Posts existing successful ParaPost system,
sided sections of the Composipost in Carbon-fibre posts are black in colour Fiber White has longitudinally arranged
the root. and do not lend themselves to use with glass fibres. The post is essentially
For retention of core materials in all-ceramic units, where they may alter parallel with small steps to aid
narrow-diameter roots such as molars or the aesthetic effect. Glass fibre has now mechanical retention of the cement lute.
mandibular incisors, RTD produce been substituted and added to the range Unlike the other fibre posts, the head of
narrow parallel-sided cylindrical posts, of prefabricated posts to overcome this the Fiber White post has two rounded
Endoposts, available in 1 mm and 1.2 mm limitation. The physical properties of sections, again to aid retention of the
diameters. The manufacturer of these posts are similar to those of core material. It is compatible with the
Composipost is the only one who carbon-fibre posts and they should existing ParaPost system in shape and
currently produces a kit of burs behave in the same way. is available in diameters of 1.14 mm, 1.25
designed for post removal and canal Aesthetipost (RTD, France). This post mm, 1.4 mm and 1.5 mm. Each post has a
reaccess. Composipost has been used retains a central core of carbon-fibre removable colour-coded ring around the
widely in Europe and has undergone bundle surrounded by quartz fibres head for identification (Figure 5).
several clinical trials. similarly arranged longitudinally. Glassix (Harald Nordin sa, Switzerland).
Carbonite (Harald Nordin sa, The next generation is the Like its carbon-fibre stablemate, the
Switzerland: UK source Blackwell Aesthetiplus post, which is composed Glassix posts have a braided fibre
Supplies, Gillingham, Kent). These posts entirely of quartz fibres. More recently, arrangement, and are presented in the
this company has produced a
translucent quartz fibre post designed to
permit light-curing materials to be used
for luting – Lightpost. All of these
variations are produced in the same
shapes and sizes as the original
Composipost (Figure 2). RTD have most
recently introduced a series of posts
with a double taper.
Snowpost (Carbotech, France).
Developed from research originally on
Figure 3. Carbonite system kit. carbon fibre by Professor Bois and Figure 5. ParaPost Fiber White kit.

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microleakage.35 Translucent posts

(Lightpost and Luscent Anchors; Figure
8) have been introduced in order to
allow the use of light-cured luting
agents. This can facilitate cement
placement and evaluation of post
seating prior to setting.
The original purpose of light-
transmitting posts was to provide a
Figure 6. Glassix glass-fibre system. means of reconstituting roots with Figure 8. Luscent Anchor posts, drills and core
overly flared canals caused by caries or matrix.
excessive endodontic preparation,36 the
same dimensions (Figure 6). aim being to achieve union between the
Mirafit White (Hager Werken, Germany). remaining dentine and a light-cured construct a directly placed composite
This is the glass-fibre version of Mirafit composite, thereby restoring the lost post and core.
Carbon. bulk and original strength of the root. Removal of the obturation material
Luscent Anchors (Dentatus, Sweden). A The technique involves inserting a and a minimal amount of dentine to
tapered shape has been adopted for the translucent plastic post into a light- facilitate insertion of the ribbon is the
Luscent Anchors. They are formed from curing composite placed within the only preparation required. One or more
translucent longitudinal glass fibres canal. The composite is then cured by lengths are coated with light-cure resin,
within a resin matrix. Three diameters, light transmitted down and through the folded into a V-shape around an
measured at the coronal end, of 1.4 mm, post. Once the composite is cured, the instrument and then carried into the
1.6 mm and 1.8 mm, are available with post is withdrawn and a matching metal canal space to be cured.38 Additional
matching burs. post luted with resin cement. The light- increments are then added to complete
FibreKor (Jeneric/Pentron, USA). Unlike transmitting properties of translucent the core build up.
the other systems here, FibreKor posts glass-fibre posts allows them to be luted For this technique to work well there
contain a filled composite as the matrix in a similar fashion with light-cure must be sufficient light reaching the
which surrounds the fibres. The fibres cements as a definitive post, with or depths of the post space. Tests on this
are glass, arranged longitudinally and without additional composite resin root system have produced conflicting
comprise 42% by weight. The composite reinforcement. The plastic posts require results as to the resulting strength of
resin and filler both make up 29% by a diameter greater than 1.5 mm to the restoration39 and its ability to
weight, respectively. These posts bear achieve complete curing to a depth of reinforce the root.40
similarities to the Fiber White posts in over 7 mm.37 The relative ability of the
their stepped parallel shape, but have no glass-fibre versions to transmit light has
separate shaping of their heads and are not yet been reported. Ceramic Posts
supplied with a useful pair of tweezers The proven ability of ceramic materials
and matching burs in three sizes (1 mm, Ribbon-fibre Materials to mimic the appearance of tooth
1.25 mm and 1.5 mm). Intermediate sizes Several manufacturers produce woven structure has been combined with
(1.125 mm and 1.375 mm) are also fibre ribbons to be used as a matrix for improvements in strength and durability
available (Figure 7). the construction of direct etch-retained to permit the use of all-ceramic
Style-post (Metalor Technologies, composite splints. Ribbond Inc. (Seattle, restorations in situations where only
London). At the time of writing, the USA) suggest that their woven metal-reinforced restorations would
Metalor company has just introduced a polyethylene fibre can also be used to previously have been placed. The use of
parallel-sided, tapered-end quartz fibre ceramic to provide a core and post
post system. This is compatible with its retention continues the idea of using a
metal prefabricated M-P post system tough but aesthetic material to support
and is produced in four widths. all ceramic units without affecting their
optical properties. If it is possible to
Light-transmitting Posts bond this tough material to the root
The setting reaction of self-curing permanently, it is hoped to restore the
cements begins rapidly after mixing and original strength of the root.
this can cause difficulty in fully seating Castable glass posts and cores,41
posts.34 Ensuring complete cleaning and glass-infiltrated aluminous porcelain
then coating of the sides of the post posts and cores produced
space is difficult, and can result in Figure 7. FibreKor composite and glass-fibre conventionally42 or machined from
reduced retention or increased post system. blocks by computer-linked systems

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the Cosmopost have produced a core consideration must also be given to

material with a coefficient of thermal the presence of caries, active
expansion very similar to that of the periodontal disease and oral hygiene,
post, which can be heat pressed onto the probable functional occlusal loads
the zirconia post via a lost wax stage. and the importance of the tooth in the
The resulting core therefore has great patient’s overall treatment.
strength and demonstrates superior A post can then be selected with a
retention to the post.46 diameter which will suit the strength
requirements of the tooth’s functional
Figure 9. Cosmopost ceramic post system Cosmopost load, while limiting the amount of
from Ivoclar. Cylindrically shaped with a conical tip, further dentine removal necessary to
the Cosmopost (Ivoclar/Vivadent, prepare a post space (Figure 10).
Leicester) is available in two relatively Having decided the appropriate length
have been developed. All of these wide diameters (1.4 mm and 1.7 mm) of the post hole, the root filling
methods required a prolonged and (Figure 9). The posts, as material can be removed with heated
technically exacting procedure for their manufactured, have a relatively instruments or Gates-Glidden drills.
construction, and the strengths of the smooth surface and are subsequently Pre-enlargement can then be
materials produced was such that their treated to roughen the surface, which sequentially accomplished to full
use was suggested only in situations increases the bond strength between depth using matched post drills of
where a wide post could be placed. the post and core, whether heat progressively larger diameters (where
The introduction of zirconium oxide pressed or luted. Although principally available) or by using small diameter
ceramics has provided a material with intended to be used with a ceramic Gates drills. This should be carried out
over twice the flexural strength of core, the manufacturers suggest that a with a light touch, allowing the drill to
aluminous ceramic systems,43,44 which composite core is suitable if one-third follow the path of least resistance, the
is therefore able to be used to of the coronal tooth structure remains. root canal. It is essential for the
construct posts of realistic diameters. operator to be relatively passive and
Implants composed of zirconia have therefore avoid driving the drill, which
been produced since the 1980s and its TECHNIQUES may create an aberrant channel or
use to construct endodontic posts The techniques for insertion of these perforation. The final stage should
was described in 1994.45 When heated, posts are essentially the same as those involve using the drill corresponding
zirconia ceramics undergo structural for metal prefabricated systems. An to the selected post size to complete
changes: the crystals change from accurate radiograph of the tooth the shaping. Having gone through a
monoclinic to tetragonal to cubic, with should be assessed to help select the series of steps, the final drill should
accompanying volume changes and appropriate post. The following need to be placed only briefly. This will
resultant stress on the material. By features should be considered: help prevent unnecessary removal of
adding yttrium oxide, a partially dentine laterally, and maintain the
stabilized tetragonal phase is
curvature of root; cutting efficiency of the drill.
achieved. When a crack is initiated in
taper of root; The canal is then cleared of debris
the ceramic, a change in phase from
width of root; and the post checked for fit (Figure
tetragonal to larger monoclinic
cross-sectional shape; 11). In the case of most of the
crystals occurs. The enlargement of
available length of canal; composite posts, the length of the
the lattice around the crack prevents it
from propagating and this behaviour (failure to relate these parameters to
contributes to the material’s enhanced the post dimensions may lead to
toughness. perforation or weakening of the root.
Zirconia ceramics have been shown The actual width of the centre of the
to be biocompatible.30 Building a core root may be much less than the
of ceramic directly onto the zirconia apparent width seen on the
posts has not been possible owing to radiograph.)
the different coefficients of thermal
expansion of the core and post
quality of endodontic seal and
materials, which would result in fracture apical condition;
Figure 10. Examples of currently available posts
of the core. Ceramic cores have thus to
periodontal bone levels for
of similar diameter. Left to right, top row: Luscent
be constructed indirectly and then support of the tooth. Anchor, Snowpost, Fiber White, FibreKor,
luted around the protruding end of the Cosmopost; bottom row: Aesthetipost,
post. However, the manufacturers of As with the restoration of any tooth, Composipost, Lightpost, Carbonite, Glassix.

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may occur.

The post space needs to be clear of
debris. The presence of a eugenol-
containing root canal sealer can
inhibit curing, leading to reduced
retention and increased coronal
leakage. Acid etching and the
additional use of ethanol will
prevent this.47
Figure 11. Preparation of the post space and
Etching of the whole of the canal Figure 13. An endodontic irrigation syringe and
trial of a glass-fibre post. needs to be ensured, as does the needle used to improve removal of etchant and
correct duration of etching. A small- debris.
diameter spiral interdental brush will
post is adjusted by using a diamond effectively place etching gel
disc to remove the excess from the throughout the prepared post space different from that of the fibre posts, and
coronal end. The Fiber White posts (see (Figure 12). this mismatch may cause stresses
above), being completely parallel and
All of the etchant must be washed between core and post. The stresses
having a shaped head, are adjusted from out and the canal dried correctly. To caused by micromovement of the post
the apical end before insertion. achieve this requires a careful can lead to problems of microleakage. It
It is intended that all of the non-metal technique, and simply using an air/ is suggested, however, that composite is
posts be luted with an adhesive resin. water syringe may be ineffective, a good choice as a core material where
The dentine sides of the post space are reducing the potential for there is substantial coronal tooth
therefore etched and washed, and excess successful cementation.35 structure remaining.49
moisture removed consistent with the Endodontic irrigation needles are
aims of the wet-bonding technique. A useful for improving the removal of
self-curing bonding material is placed etchant (Figure 13). Some luting ADVANTAGES OF NON-
into the canal, followed by the self-curing resin systems do not require a METAL POST SYSTEMS
luting cement. Some cement is placed separate etching stage and may A major advantage of fibre posts is that
around the post itself, which is then therefore be easier to use. the technique for removing them (with
inserted, and excess cement removed.
The luting cement must be placed rotary instruments) in the event of
Once the post cement is cured a core carefully to coat the entire canal fracture or need for endodontic
material, usually resin composite, can wall, and the post inserted quickly retreatment is much simpler than that
then be built up around the post. For a to ensure full seating before curing
ceramic post the ceramic core may be commences.34 Refrigerating the
fabricated indirectly, heat-pressed onto luting composite will extend the
the post or fabricated separately and then working time.
cemented. A direct core of composite is
also suggested as a suitable alternative A light-curing restorative composite
technique. can then be built up to form a core
Realizing the potential of resin (Figures 14 and 15). Composite is
composites requires very careful usually envisaged as the direct core
technique and several stages are material to be used in conjunction with
involved, at any one of which problems these prefabricated posts. The physical
properties and behaviour of resin
Figure 14. Core build-up with light-curing
composite, however, are not ideal for composite.
this purpose:

it has adequate but not great

strength;

its co-efficient of thermal expansion
is substantially higher than that of
tooth structure; and

its tendency to absorb water makes
it dimensionally unstable.48
Figure 12. Use of an interdental brush to etch
the walls of the canal fully. The flexural modulus of composite is Figure 15. Completed core preparation.

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needed to remove metal posts.50 With this type of test does not mimic the are many and varied combinations of
glass-fibre posts there is also an pattern of loading occurring in vivo, a resins and reinforcements being
aesthetic advantage. Zirconia ceramic number of investigators have used developed industrially and it is likely
posts also have good aesthetics but fatigue testing, in which the post that the non-metal posts introduced to
may prove difficult – or impossible – to systems are subjected to intermittent dentistry so far will continue to be
remove. loading at lower levels. Such studies modified and evolve alongside their
In comparison with non-precious found fewer failures with carbon-fibre industrial counterparts.
posts, non-metal systems undergo no posts53,20 than with metal or zirconium
corrosion and are more biocompatible. posts.
A possible goal of using dentine- A number of clinical studies show
bonding agents to cement a post would promising results for both fibre posts54 REFERENCES
be to unite the encircling dentine with the and ceramic posts.46 These are short- 1. Ring ME. The eighteenth century. In: Dentistry; An
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would be particularly advantageous of a post-retained restoration depends 2. Kantor ME, Pines MS. A comparative study of
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3. Trabert KC, Caputo AA, Abou-Rass M. Tooth
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4. Guzy GP, Nicholls JI. In vitro comparison of intact
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28–35.
at failure exceed those that would reliance on as-yet unproven attributes
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curriculum in many dental schools have finally progress to general practice.

BOOK REVIEW resulted in an increase in the teaching The booklet contains many helpful
Secrets of Success in Dental Practice – of Behavioural Sciences within the hints on organization of reception and
99 Things They Didn’t Tell You in curriculum and it is to be hoped that, appointment systems and also in-surgery
Dental School. By Philip R. Greene. despite the title of the booklet, many of behaviour for the dental team. Perhaps
(Available from Dept DEU Quayside Mr Greene’s 99 points have been one of the most important sections is
Dental Centre, 2 Chester Road, touched upon within such courses, dealing with conflict with patients and,
Manchester M15 4WX. Tel. 0161 835 particularly with regard to developing although in any such publication one
1777; email: dentalbooklets@[Link]) rapport and friendship with patients. It would not agree with all the methods and
Price: £45 plus sae. is also expected that undergraduate suggestions contained therein, this small,
schools stress the need for slim volume does contain a wealth of
This slim booklet introduces itself as a organization when treating patients. thought-provoking material. It is not
guide for practitioners who wish to enjoy Unfortunately, for many appropriate as an undergraduate text, but
themselves within their practice undergraduates, mastering the practical would be a most useful reminder for
environment, working in a happy and and academic content of the BDS those in their early years in practice and
friendly place where everyone helps each course, especially the need to pass particularly those in their vocational
other. It would be difficult to argue with examinations, can lead to a lack of training year.
such aims in any workplace. appreciation of the importance of their Richard Caddick
Changes in the undergraduate dental behaviour and organization when they Birmingham Dental School

336 Dental Update – September 2001

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