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From: Marga Ree
To: ROOTS
Sent: Thursday, June 09, 2005 3:05 AM
Subject: [roots] resilon follow-up
Tooth # 36 has been treated by an endodontist several years ago.
Moreover, apical surgery has been performed due to persistent AP.
Last year I did a retreatment, root canal filling of resilon. Unfortunately I damaged the crown,
a piece of porcelain broke off during post removal with U/S and the post puller.
Today I did the 8 month follow-up, rad shows healing. Patient is scheduled for a new crown - Marga
Correction, YOU did NOT damage the crown the placement of a probably not needed post and its subsequent
need for removal damaged the crown. Surly you do NOT feel responsible! Very nice re treatment! - Alan Cady
What always cracks me up is how we can REMOVE the post from inside a crowned tooth retreat the endo seal
it up again and it has virtually NO effect on crown retention in most cases.
Therefore – what is the relative VALUE of the post in retaining the core???!! Minimal. So why put a post
in a canal if you have decent tooth structure left? All that does (besides increasing the initial restorative
AND retreatment fees) is make it harder to retreat! Oh….I know! Its to justify the purchase of the
Ruddle Post Puller. !!! Right!?
Also, in some teeth, you risk damaging the porcelain by having to enlarge the access to allow for
straight line pull of the post puller.
Marga, were they planning to remake the crown from the start? OR did they have to do it as a result of the
porcelain fracture? If they were planning on remaking the crown anyway - why not just take the crown off
in the beginning and make post removal/access easier? - Robert M. Kaufmann
In defense of that, I was taught to do that in dental school, and advised that made the whole thing stronger. As we
now know, and that’s why I mentioned the article in the may jada, that posts have nothing to do with strengthening.
Most of the guys on the planet are sticking them in. relatively few of us are taking them back out (2 hours yesterday
just to get the post out; I’ve got to get to one of those 15 minute endo classes.) - Gary
Rob, This crown was not planned to remake from the start. What I usually do is explain the patient that
I am going to try to maintain the restoration, but that there is a fair chance that the crown will need
replacement after the disassembly. So they know on forehand that this is part of the deal.
Ususally I manage to keep the restoration undamaged, so then it is a piece of good luckfor the patient that
only the endo is needed. - Marga
Bob, there is zero doubt that the vast majority of posts that are placed are not necessary. In my opinion they are
poorly retentive for the crown. In most cases where I use a post, it is when I am not going to be able to place a
crown or retain a core without it. The post I made on "Swamp dentistry" shows a case where there was plenty off tooth
structure left but my desire to have as perfect a crown prep as possible made a core necessary which required a post to
retain it.
The main value of posts is that they can be charged for and if the crown placement is immediate, it is very difficult
to determine whether they are necessary. I can show you a case where 16 virgin teeth were treated endodontically, post
and cores placed, and followed with crowns. Neither the endo nor the cores were necessary. It was simply a
billing/charge factor. The state board now has that case. The vast majority, in my practice, are used to retain a
buildup or large restoration when the patient is doing the endo but delaying the crown. The damn things are a pain in
the ass because they simply are not retentive and I've used everything (saying this again) from cast posts to cut off
bur shanks, to almost every type of prefab on the market. The Flexi type posts have proven to be more retentive than
any others (and easier to remove) and I'm facing the treat of a fractured root...although I see very few fractured
roots because of posts. I see more perfs placing the posts. Billing is the answer, Bob...not necessity. Guy
Tooth # 36 - Resilon follow up
