|Year : 2016 | Volume
| Issue : 1 | Page : 76-80
Clinical performance of a new post system: I post
Tanushree Sancheti, Lalitagauri Mandke
Department of Conservative and Endodontics, Dr. DY Patil University School of Dentistry, Navi Mumbai, Maharashtra, India
|Date of Web Publication||12-Feb-2016|
Dr. Lalitagauri Mandke
Bi, 7:2, Sneh CHS, Sector 19A, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
One of the important stages in endodontic therapy is to restore the tooth with a stable restoration for mastication and aesthetic purposes. Posts have been used effectively and successfully for postendodontic restorations. This case report presents the use of a new post system - I post, a prefabricated metal post with a unique design. Two posterior teeth were restored postendodontically with the I post, with a follow-up of 3 months. The teeth were asymptomatic, and radiographic evidence showed that the posts were in position with no evidence of fracture or coronal leakage. This new post system will go a long way in providing the clinician with a predictable and efficient prosthesis foundation.
Keywords: Coronal flare, I post, postendodontic restorations
|How to cite this article:|
Sancheti T, Mandke L. Clinical performance of a new post system: I post. J Int Clin Dent Res Organ 2016;8:76-80
| Introduction|| |
The best plan for success is to begin with the end in mind. A successful endodontic treatment has to be complemented with an adequate postendodontic restoration to make the pulpless tooth function indefinitely as an integral part of the masticatory apparatus. 
The amount and quality of the remaining tooth structure are important factors in dictating the choice of the restoration. In cases of extensive loss of external tooth structure a post is required, its primary purpose being to retain the core.
I post is a new post system with unique features developed by integrated endodontics.
The objective of this case report is to show the effective use of I post in postendodontic restorations.
I post [Figure 1] is a passive, parallel, pillar-like metal post made of stainless steel alloy. This post has a unique design, which compensates the anatomic flare of the coronal part of the root canal.
The rationale behind this design is as follows:
Every canal has a natural/anatomic coronal flare, which needs to be compensated by the post. The anatomic flare, if not compensated, may lead to loosening of the post and ultimately failure of the treatment. The I post has an innovative design with a pillar-like shape coronally, which fits into the coronal flare of the root canal. Its passive parallel design prevents fracture of the root under mastication, Thus, I post enhances retention and resistance features of the postendodontic restoration.
I posts are available in four sizes matching with #2, #3, #4, and #5 Peeso drills [www.integratedendo.com].
We present two cases where I post was used successfully. In both cases, all procedures were performed in compliance with the relevant laws and institutional guidelines. The protocol was approved by the institutional ethics committee.
| Case Report|| |
A 70-year-old male patient came to the Department of Conservative Dentistry and Endodontics, with the chief complaint of pain with respect to the upper left back region since 15-20 days. The patient gave a history of trauma during chewing, which led to fracture of the tooth 25. The patient was in good general health and the medical and dental histories were noncontributory.
Intraoral examination revealed fracture of the palatal cusp of 25 [Figure 2]. The tooth was tender on vertical percussion; electric and heat pulp testing showed delayed response. Radiographically, a widening of the periodontal ligament with loss of lamina dura was observed. Endodontic therapy was planned in relation to 25 followed by post and core to rehabilitate the fractured palatal cusp to the normal occlusal anatomy. Informed consent was obtained from the patient.
Access opening was carried out, two canals were traced, namely, the buccal and palatal, working length was established using apex locator and it was confirmed with radiograph. Cleaning and shaping were done using rotary ProTaper files (Dentsply, India) with intermittent irrigation with saline and 5% sodium hypochlorite till F1. The canals were obturated using F1 Protaper gutta percha cones (Dentsply, India) with AH plus (Dentsply, India) as the sealer by lateral compaction technique [Figure 3]. Access cavity was sealed with temporary restoration and the patient was recalled after 3 days for post and core. On the recall visit, the patient was asymptomatic; hence, post and core treatment was initiated.
|Figure 3: tooth no 25 (a) obturation (b) post space preparation (c) post trial (d) post cementation and (e) core build-up|
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Gutta-percha was removed from the palatal canal, leaving 5 mm apically. Post space preparation was carried out using Peeso reamers (Mani, India) [Figure 3].
Palatal canal was prepared up to size Peeso no. 2. Therefore, the corresponding post, i.e., I post no. 2 was selected and tried in the canal. The tip of the I post was cut with the help of air rotor till the flare of the I post matched the anatomic coronal flare of the palatal root canal orifice. A radiograph was taken to confirm the length of the post as well as the fit. Before cementation, the head of the I post was cut so that there was a 2-2.5 mm of occlusal clearance for the crown preparation. Isolation was carried out with cotton rolls. The canal was dried with paper points and the post was cemented with luting type 1 glass ionomer cement (GIC) (GC Fuji, India). The core build-up was carried out using nanohybrid packable composite resin (3M) (3M ESPE, India) [Figure 3].
Subsequently, crown-lengthening procedure was carried out on the palatal surface due to insufficient margin cervically. Crown preparation was carried out in the next visit. The preparation was made for porcelain-fused-to-metal crown. Impressions were made in rubber base impression materials using a two-step technique. Metal try-in was done in relation to 25 and final crown cementation was performed using luting type 1 GIC (GC Fuji, India) after the occlusal adjustments were done [Figure 4]. Follow-up was done up to 3 months, which showed uneventful healing [Figure 5].
|Figure 4: tooth no. 25 (a) crown preparation (b) impressions (c) metal try-in (d) laboratory processed ceramic crown (e) ceramic crown cementation|
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In the second case, a 42-year-old female patient came to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain with respect to the lower right back region since 1 month. Pain was initially gradual in onset but later it became continuous and throbbing in nature, which was relieved on intake of analgesics temporarily. She was otherwise healthy with noncontributory medical and dental histories.
Intraoral examination revealed deep proximal caries with respect to 46, which was tender on vertical percussion; electric and heat pulp testing reveled no response. Radiographic examination showed deep distoocclusal caries involving the pulp and approaching the furcation area. There was radiolucency in the furcation area suggestive of furcation involvement with 46.
Bicuspidization was chosen as a treatment option due to the presence of a large carious perforation through the crown into the furcation area with more than 3 mm of probing depth, along with vertical bone loss. Bicuspidization would make the area more cleansable and improve the prognosis of the tooth.
The treatment planned was endodontic treatment followed by I post in the distal root and bicuspidization of 46. The patient was explained about the treatment and written consent was obtained from her. The endodontic treatment was carried out in a similar manner as in the previous case [Figure 6].
|Figure 6: tooth no. 46 (a) obturation (b) post space preparation (c) post trial and (d) post cementation|
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After the endodontic treatment access cavity was sealed with temporary restoration, the patient was recalled after 1 week for postendodontic restoration. On the recall visit, the patient was asymptomatic; hence, post and core treatment was initiated.
Gutta-percha was removed from the distal canal leaving 5 mm apically. Post space preparation was carried out using Peeso reamer (Mani, India); the distal canal was prepared till size Peeso no. 2. Correspondingly, I post no. 2 was selected and tried in the canal.
The post was adjusted and a radiograph was taken to confirm the length of the post as well as the fit. Before cementation, the head of the post was cut so that there was enough occlusal clearance for the crown preparation.
The post was cemented with luting type 1 GIC (GC Fuji, India) and the core build-up was performed using nanohybrid packable universal restorative composite resin (3M) (3M ESPE, India) [Figure 6].
Biscuspidization procedure was carried out using thin tapered fissure bur. After bicuspidization procedure, crown preparation was carried out for both the mesial and distal halves to receive two separate metal crowns respectively. Impressions were made in rubber base impression materials using two-step technique. Metal crown cementation was carried out using luting type 1 GIC (GC Fuji, India) after the occlusal adjustments were done [Figure 7]. A 3-month follow-up revealed satisfactory healing [Figure 8].
|Figure 7: tooth no. 46 (a) bicuspidization procedure (clinical view) (b) RVG showing crown sectioning (c) impressions (d) metal crown cementation|
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| Discussion|| |
A combination of good coronal restoration and endodontic treatment is mandatory for the long-term success of a restored root-filled tooth.  Posts have evolved immensely as a postendodontic restoration since their first use in as early as the 1700s.
With the wide range available today, selecting an ideal post has posed a dilemma to the clinician.
The recent advances in stainless steel posts, with improved design and physical properties have made them popular for restoring posterior teeth. Various opaquers can also be used to mask the head of the post, if aesthetics is required. They are preferred as forces of mastication are higher in the posterior region.
Parallel posts are more retentive than tapered posts. , They induce less stress into the root because there is less of a wedging effect, and are reported to be less likely to cause root fractures than tapered posts.  In a retrospective study, Sorensen and Martinoff reported a higher success rate with parallel posts than tapered posts.  Active posts are more retentive than passive posts; however, they increase stresses in the tooth structure.  Currently, most clinicians prefer parallel and passive posts due to the abovementioned benefits.
However, every root canal has a coronal flare, which has not been considered in the currently available post system designs. This can lead to compromised post retention, ultimately leading to failure.
Keeping this aspect in mind, an innovative post design (I post) was developed by integrated endodontics.
The I post design is unique, i.e., it is passive, parallel, serrated, and pillar-like in appearance. The parallel and serrated design aids in retention of the post. Since it is passive, there is less stress concentration along the root surface. This post has a peculiar design, which compensates the anatomical coronal flare of a root canal. This shape enhances the retentive features of this post system. The other advantages of I post include good strength (made of surgical grade stainless steel alloy), its user-friendliness as it matches with Peeso reamer sizes, and that it is economical.
The two cases highlight the successful use of I post for postendodontic rehabilitation.
| Conclusion|| |
Postendodontic restorations are becoming an important and integral part of today's dentistry and a good postendodontic restoration in turn determines the success of the root canal treatment.
Even though the I post has gained popularity among the dental fraternity and is being widely used, there are no studies or case reports, which support and justify its use. The superior qualities of the I post, in combination with skilled integration of endodontic and restorative procedures and the clinicians' expertise, will certainly ensure long-term success of the teeth.
Dr. Anish Naware, Master of Dental Surgery (MDS) (Conservative Dentistry and Endodontics) founder of Integrated Endodontics who has designed and patented the I post.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chandra BS, Gopikrishna V. Grossman′s Endodontic Practice. 13 th
ed. New Delhi: Wolters Kluwers India Pvt Ltd; 2014. p. 398.
Kishen A. Restorative considerations for root-filled teeth. Chapter 19. In: Kohli A, editor. Textbook of Endodontics. New Delhi: Elsevier; 2010. p. 288.
Standlee JP, Caputo AA, Hanson EC. Retention of endodontic dowels: Effects of cement, dowel length, diameter and design. J Prosthet Dent 1978;39:400-5.
Johnson JK, Sakumura JS. Dowel form and tensile force. J Prosthet Dent 1978;40:645-9.
Martínez-Insua A, da Silva L, Rilo B, Santana U. Comparison of the fracture resistance of pulpless teeth restored with a cast post and core or carbon-fiber post with a composite core. J Prosthet Dent 1998;80:527-32.
Sorenson JA, Martinoff JT. Clinically significant factors in dowel design. J Prosthet Dent 1984;52:28-35.
Felton DA, Webb EL, Kanoy BE, Dugoni J. Threaded endodontic dowels: Effect of post design on incidence of root fracture. J Prosthet Dent 1991;65:179-87.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]