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Posts
After a tooth has had its nerve tissue removed by endodontics (root canal treatment), very often there is little remaining undamaged tooth structure. Before a restoration is placed, whether it is a crown (cap) or a silver or bonded filling, a post is placed into the tooth to help give support and retention to the remaining tooth and subsequent restoration. The post can be a cast custom-fitted post or a prefabricated post. The prefabricated post is made in various diameters, materials, and lengths. It may be metal or tooth colored. A special drill is used to remove part of the root canal filling material (gutta percha) and prepare and shape the canal for the post. Once the post has been fitted, it is either cemented into place with a glass ionomer material or bonded with a resin cement. Choice of cementing medium is affected by the length of the post, location of the tooth that the post is to be in, and past history of dental decay. If the existing root canal has been filled with silver points, they must be removed before the crown can be constructed. The cement that holds the silver points in the canals has been shown to dissolve quickly. The new crown must be placed over a sound root canal filling in order to avoid future endodontic problems that might require removal of the new crown.
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The post will help the tooth resist some of the stresses that it undergoes when you chew hard or sticky foods. It will reduce the possibility that the tooth will shear off at the gumline. It will also serve to retain any filling, crown, or core buildup material that has been used in the tooth. It is still possible for the tooth to fracture, even with a post in place. It is also possible that the post may become dislodged if you eat especially hard or sticky foods and bite the wrong way. The more original tooth you have left, the less likely this is to happen.
Core-Crown Buildups
A core buildup or crown buildup is placed when there is insufficient tooth structure remaining to retain the future crown. It can be made out of silver amalgam, bonded resin, or glass ionomer. The choice of the material used relates to how much tooth is missing and how long the tooth must be in place without the final crown being cemented. Usually, if a post is placed, a buildup is also required. The more real or artificially reconstructed (core buildup) tooth structure there is available, the better the final crown will stay in place.
Crown Lengthening
Crown lengthening by laser or conventional surgery is a procedure that is performed to correct one of the following conditions:
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Insufficient tooth clinically remaining to allow proper retention of a crown. |
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Sound tooth structure that is beneath the gingival (gum) tissue. |
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Gingival tissue that is in poor position or contour. |
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Laser permits the repositioning, modification, or removal of soft tissue by employing a calibrated electric current. Conventional surgery is done with a scalpel and involves suturing. When there is insufficient tooth structure available for crown retention, the adequate tooth structure must be exposed, and the necessary gum tissue, removed. When the tooth cannot be kept isolated and dry during dental procedures, it becomes much harder, sometimes impossible, to get a satisfactory result. Saliva, blood, and water from your mouth affect dental material in an adverse fashion. Removing excess and unwanted tissue allows the tooth to be kept dry, thus increasing the possibility of a good result. Simply stated, when the dentist cannot see the work area, the results will probably not be satisfactory. There is very little postoperative pain associated with the laser procedure. Most patients say that it feels like a burn from hot cheese on a pizza. A nonprescription pain reliever is usually adequate. Occasionally, the crown lengthening cannot be adequately completed with laser. Surgical crown lengthening will require sutures and delay in the final impression for the crown while the tissue heals. Four to eight weeks' healing time is usual. When either type of crown lengthening is not done, the chance of clinical success of the crown is seriously reduced.
All posts, core-crown buildups, and crown lengthening are grouped together on this page because it is very common that these procedures need to be done together. If a tooth needs a root canal treatment, it is usually fairly well broken down and difficult to restore. Each procedure may be called for on its own, or with one or both of the other procedures. If any of these procedures need to be done, there will be a fee charged separate from the crown fee.
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