CAST POST & CORE

Fabrication Technique

Preoperative condition of the tooth. Tooth may

be fractured and/or contain various amounts of
temporary or permanent restorative material.

The tooth will probably have temporary (or

permanent) restorative material in the endodontic
access opening. There may be a cotton pellet
under the temporary.

Reduce the tooth axially and incisally. Tooth

should receive full reduction commensurate with
final crown preparation. Preparation of axial and
incisal tooth structure facilitates access and
makes gutta percha removal easier. Final
margination need not be done at this time.
Alternate First Step: You may have an exact
recorded measurement of canal length relative to
a known landmark (e.g. incisal edge). If you are
totally confident of the measurement (e.g. you
personally did the endodontic treatment on this
tooth) you may remove the gutta percha prior to
axial and incisal reduction (refer to technique
below).

Be careful not to rely solely on measurement of

radiographs (since there is usually a
magnification error) or someone else's
measurements (which may be recorded in error or
may have been made relative to a different
landmark).

Remove all old permanent and/or temporary

restorative material (including material in the
access opening and pulp chamber). Remove all
caries.

Remove any undercuts created by removal of the

restorative material and/or caries. Remove any
undercuts from the pulp chamber. All undercuts
must be either removed with a diamond or
blocked out with a base (do not use eugenol
containing material that will inhibit set of
acrylic).

If undercuts cannot be successfully eliminated, a

technique other than the one described below
must be employed to fabricate the post/core
pattern.
 page 2

Remove any weak, thin, and/or unsupported

tooth structure. Do not remove any more
sound tooth structure than is necessary to
accomplish the above steps.

If additional tooth structure has not been

removed from parts of the incisal edge
(beyond the initial reduction), then reduce the
incisal in these areas an additional 1.0 mm so
that the entire incisal edge of the tooth will
ultimately be covered by metal of the cast
post/core. Use a shallow contrabevel on the
incisal edge.

With a hot instrument (Glick heated over a

Bunsen burner) remove gutta percha from the
coronal portion of the canal to better visualize
the direction of the canal. Experienced
operators may opt to go directly to removal of
gutta percha with a Pesso reamer, but care
should be taken not to get "off-line" and
perforate the root.
Using progressively larger diameter Pesso
reamers remove the gutta percha to the
predetermined initial depth (established by
measurement of a radiograph). Use a rubber
stop placed on the shank of the instrument.
Stop short of the intended final depth and
confirm the amount of gutta percha removal
with another radiograph.

Repeat this process as necessary leaving 4-5

mm of gutta percha as an apical seal. Make a
final radiograph when gutta percha removal
has been completed. Do not arbitrarily enlarge
the canal in diameter. A #3 Pesso reamer is
usually more than adequate (remember a #3
Pesso = #4 Gates = #110 file).

If there are no irregular features in the tooth

preparation you may need to add a keyway to
resist rotation of the post/core. Place the
keyway in the bulkiest part of the remaining
tooth structure. Use a small diameter tapered
diamond or bur. A single keyway is sufficient
(two shown in diagram*).

*Shillingburg 2nd edition p. 151

Be sure that you have a path of draw for the

coronal portion of the tooth preparation that is
consistent with the direction of the canal. You
may need to "flare" the access opening slightly
at this point so the Duralay acrylic does not
get locked-in during the fabrication of the
post/core pattern. Do not use high speed
instrumentation in the canal itself (pulp
chamber only).
 page3

Be sure there is a positive vertical stop

for the post/core so that the casting does
not act as a wedge (which may split the
tooth). This may be a flat area (90
degrees relative to the path of draw) or a
slight contrabevel around the perimeter of
the preparation (creating a "ferrule"
effect). Fabricate a temporary crown
before making the post/core pattern.

Try-in the preformed plastic post and be

sure it goes all the way down the prepared
canal without binding (a totally passive
fit). Trim it as necessary or custom make
a post from a plastic sprue pin. Measure
the post relative to the depth of the canal
with a periodontal probe if you are not
sure.

Lubricate the canal with Duralay

lubricant. Use a perio probe, paper point,
or cotton on a barbed broach to carry the
lubricant to place. A thin coating is all
that is necessary. Do not leave the canal
filled with lubricant. Also be sure a thin
layer of lubricant covers all coronal
surfaces of the tooth that will come into
contact with the Duralay resin.

Be sure you check the fit of the post

before you lubricate the canal so the
lubricant does not interfere with the
bonding of the Duralay to the plastic post.
Using the "bead brush" technique, fill the
canal completely with Duralay resin. Use
the bristles of a brush (bent at a 45 degree
angle for easier access) to force acrylic
down the canal and express any trapped
air.

Immediately, dip the plastic post in

acrylic liquid (to soften post and enhance
bond of acrylic) and seat it in the canal to
its full depth. Allow the Duralay to set
completely. Some clinicians advocate
moving the post up and down in the canal
1-2 mm (only after the Duralay is nearly
set) to avoid getting it "locked in." If this
method is used, do not remove the post
from the canal until the Duralay is
completely set.

Using hemostats, carefully remove the

post pattern and inspect it to be sure it is
fully formed (with no voids). If the post
should break it can usually be removed
by heating an instrument and "searing it"
to the plastic post in the canal. After
cooling, the plastic post will be stuck to
the instrument and can be removed. Great
care should be exercised if an attempt is
made to remove the post with a rotary
instrument (e.g. Pesso reamer) since the
instrument may easily cut the lateral wall
of the canal (instead of the plastic post)
and cause a perforation. After removal of
a broken post, be sure there are no
undercuts (you may want to lightly
resurface the walls of the canal again with
a Pesso reamer) and relubricate before
proceeding.
 page 4

If the post portion of the pattern is acceptable,

place it back into the canal (it is easier to remove
with hemostats, but easier to replace with your
fingers). Be sure it goes completely to place. If
unacceptable, attempts to add acrylic to a
deficient post usually result in a post that cannot
be reseated completely. It is generally easier to
make a new post before continuing.

Cut off the top of the plastic post so that your

patient can close completely (the patient has
probably had his/her mouth open a good while at
this point). Do not try to maintain the top of the
plastic post to use as a casting sprue.

Use the "bead brush" technique to build the core

portion of the pattern to full contour. Build in
small increments so that the Duralay does not
"slump and run" making the subsequent
preparation step more difficult. The core portion
should be slightly overbuilt (avoid grossly
overbuilding which will only necessitate
additional preparation later).
Using a large diameter coarse diamond (high
speed handpiece at "near stall" speed with water
spray), shape the pattern to ideal preparation form
(on the tooth). If the handpiece is used at high
speed the diamond will tend to burn the acrylic.
Have patient close in order to check lingual
clearance. Be sure there is at least a 1.0 mm "cap"
of acrylic over the entire incisal of the tooth
preparation.

Using hemostats (held mesiodistally), remove the

pattern from the tooth. The pattern should not be
removed (except one time to check that the post
portion is fully formed) until it is completed.
There is the risk of breakage each additional time
the pattern is removed.