The ENDODONTIC Restorative Harmonic: Part I Access To Apex, Apex To Access

The restoration of endodontically treated teeth (ETT) has been guided historically by anecdotal empiricism rather than biomechanical dynamics. 

Decisions regarding the configuration of the restoration, the diameter of the post channel and the post and core materials to be used have plagued foundational dentistry for decades.

The loss of coronal tooth structure due to caries, excessive access cavity design and the taper of the root canal preparation are vectors that will create stress at the cervical region during functional loading. 

The ongoing confusion regarding design and materials has caused paradoxical statements and illogical contradictions to be factored into the restorative matrix for ETT.

The introduction of fibre posts has altered the root to restoration harmonic. Fibre posts provide a reliable alternative to metal posts (cast or prefabricated) as their modulus of elasticity (20 GPa) is closer to dentin than metal posts (200 GPa). 

Stiff, hard metal posts transfer forces along their long axis creating a wedging effect on tooth structure. This can lead to catastrophic failure. The use of fibre posts obviates such an event.

Kenneth S. Serota, DDS, MMSc

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