Restoring severely decayed primary teeth, particularly maxillary anterior teeth affected by early childhood caries (ECC), remains a significant challenge in pediatric dentistry.
The loss of substantial coronal tooth structure compromises both function and aesthetics, impacting mastication, speech development, and psychological well-being.
In such cases, endodontic treatment followed by post and core restoration becomes essential to maintain these teeth until their natural exfoliation.
The unique anatomy of primary teeth—including thinner enamel and dentin, larger pulp chambers, and physiological root resorption—necessitates careful selection of post materials and techniques.
An ideal post system for primary teeth should provide sufficient retention and resistance, be biocompatible, and resorb at a rate compatible with the natural exfoliation process.
Types of Posts Used in Primary Teeth
Several post systems have been explored for restoring primary teeth:
✔ Omega-shaped and Modified Omega-shaped Posts
These custom-made stainless steel wire posts are shaped into an omega (Ω) form and adapted to the root canal. They offer simplicity and cost-effectiveness but may lack optimal aesthetics.
✔ Glass Fiber Posts
Prefabricated posts made of glass fibers embedded in a resin matrix provide superior aesthetics and favorable mechanical properties. They bond well with composite resins and distribute stress evenly, reducing the risk of root fracture.
✔ Polyethylene Fiber Posts (e.g., Ribbond)
These flexible, translucent fibers can be adapted to the canal shape and offer good aesthetics and fracture resistance. They are particularly useful in cases with minimal remaining tooth structure.
✔ Metal Posts
Prefabricated metal posts offer high strength but are less favored due to poor aesthetics and potential interference with natural root resorption.
✔ Biological Posts
An emerging concept involves using natural tooth materials, such as extracted primary tooth roots, as post material. This approach aims to enhance biocompatibility and mimic natural resorption patterns.
Indications for Post Placement
Post placement in primary teeth is indicated when:
✔ More than half of the coronal tooth structure is lost.
✔ There is sufficient root length and at least 1 mm of supragingival tooth structure to support the post.
✔ The tooth has undergone successful pulpectomy and is free from infection.
It is contraindicated when there is excessive root resorption, inadequate root length, or poor prognosis due to periodontal or periapical pathology.
Clinical Considerations
When selecting a post system for primary teeth, clinicians should consider:
✔ Resorption Compatibility
The post material should resorb in harmony with the natural exfoliation of the primary tooth to prevent interference with the eruption of the permanent successor.
✔ Retention and Resistance
Adequate retention is necessary to support the coronal restoration, especially in cases with minimal remaining tooth structure.
✔ Aesthetics
In the anterior region, aesthetic considerations are paramount. Fiber posts offer superior aesthetics compared to metal posts.
✔ Ease of Placement
Given the limited cooperation of pediatric patients, the post system should allow for quick and straightforward placement.
Conclusion
The restoration of severely decayed primary teeth using post and core systems is a viable option to maintain function and aesthetics until natural exfoliation.
The choice of post material should be guided by factors such as resorption compatibility, retention requirements, aesthetic demands, and clinical ease of use.
Emerging materials and techniques continue to enhance the outcomes of such restorations, contributing to the overall well-being of pediatric patients.
References
- Martin AG, Shivashakarappa PG, Arumugam S, et al. Posts in Primary Teeth–Past to Present: A Review of Literature. Int J Clin Pediatr Dent. 2021;14(5):705-710.
- Sharma N, Goyal P, Goyal V, et al. A paradigm of esthetic post and core in primary dentition - A review. Ind J Clin Res Dent. 2023;4(2):16-23.
- Shah S, Bargale S, Anuradha KVR, Patel N. Posts in Primary Teeth-A Sile for Better Smile. J Adv Med Dent Scie Res. 2016;4(1):58-64.
- Fathima Shamsuddin N, Vinod A, Dsouza EN, et al. Unveiling the Post and Core Wonders in Primary Teeth-A Series of Case Report. Int J Adv Res. 2024;12(05):747-754.
- AAPD. Use of Non-Vital Pulp Therapies in Primary Teeth. Pediatric Dentistry. 2019;41(6):325-333.
