Advanced Endodontics


What are the considerations and techniques for post removal?

Before entertaining any post removal method, the clinician should have complete access to the pulp chamber floor, and have removed all materials circumferential to the post. Factors that will influence post removal are post diameter, length and the cementing agent. Posts can be catalogued into parallel versus tapered, stock versus cast, actively engaged versus non-actively retained and metallic versus non-metallic compositions. Additionally, other considerations include available interocclusal space, existing restorations and if the post head is supra- or sub- crestal. The first line of offense to remove a post is utilizing piezoelectric ultrasonic energy. The P5 (Dentsply Tulsa Dental) power source in conjunction with the ProUltra ENDO Tip #1 (Dentsply Tulsa Dental) will transfer energy, powerfully vibrate, and dislodge most posts. Importantly, the dental assistant should periodically dispense a water coolant into the pulp chamber to reduce the transfer of heat to the attachment apparatus. The majority of posts can be safely and successfully removed in about 10 minutes.

When a post cannot be removed with ultrasonics, is there any other backup techniques that can be employed?

Certain posts resist removal even after ultrasonic efforts using the “10 Minute Rule”. Clinicians need a fall-back position to liberate these posts from the canal. The Post Removal System (PRS) (SybronEndo) is the next line of offense and provides an extraordinary opportunity to remove a post or other intracanal obstructions. In this removal method a trephine is used to machine down the most coronal aspect of the post 2-3 mm. Then a correspondingly sized tap is screwed in a counterclockwise direction to securely engage the post head. Once the tap is firmly seated and engaged on the post, the extracting pliers are used to safely and progressively elevate the post out of the canal. More information on the PRS system is posted to the Inventions page of this site. In addition, I also refer you to my Ruddle on Retreatment DVD "Removal of Posts and Broken Instruments" to exactly explain this precise clinical technique.

How do you remove an endo-post in zyrcon or glass-fiber?

Generally, with the aid of a microscope, I drill them out - it is not easy and it is time-consuming, but possible. Good luck!