A crown with post is a restorative dental procedure which combines a crown with a post and core to restore root canal treated teeth. They are essentially two separate procedures but are required to be done together to complete treatment for endodontically treated teeth.
Table of contents:
What is a post with a crown?
Teeth with a post and crown is a tooth that has a post and core procedure and a crown procedure completed on it. Both of these two components are permanently cemented onto the tooth. They are effectively two separate treatments that are done to it.
Below are photos which show what we mean.
What it looks like when the post is separated from the crown.
How it looks with just the post inserted into the crown.
What it looks like when the post is cemented to the tooth but with crown off.
The three photos above should give you an idea of what we mean by this being two separate dental procedures.
The x-ray below shows how a crown with a prefabricated screw post looks like when they're cemented together.
The x-ray below show front teeth crowns with cast posts in them.
Appearance
We've also created a video which showcases what a post with a crown looks like just to drive the point home.
Types
There are in fact many different types of crowns and posts made in various materials. You can mix and match them in any combination which creates a unique outcome.
Types of crowns:
Ceramic - zirconia, emax, porcelain
Metal - gold and cast metal
PFM - porcelain fused to metal
Types of posts:
Cast post and core
Prefabricated post and core
Screw type
Fiber glass post
Titanium
Gold plated
When it's needed
A crown and post are only needed after a tooth has finished root canal treatment. It's purpose is to restore lost and damaged tooth structure so that you can have a fully functioning tooth.
Why a crown is needed:
Root canals remove the nerve and blood supply from the tooth.
Tooth becomes brittle overtime due to lack of access to nutrients.
You can fracture your tooth if you bite into hard foods.
Crowns offer protection to prevent or minimize tooth fractures.
Why a post and core is needed:
After a root canal with full excavation of decay, shape of tooth is unfit for a crown.
The post and core restores the missing tooth structure and creates a shape that permits the placement of a crown.
Without this procedure, crowns typically won't fit or lack retention.
Can I get it without a root canal?
You cannot and shouldn't have a post placed into a tooth without a root canal. The reason is because the post is inserted directly into the nerve canal. If the nerve is still there, it would be extremely painful and it will cause the tooth to die.
Therefore, this procedure is needed and can only be done on teeth that have already had root canals on them. Non-endodontically treated teeth are not eligible for this procedure.
How much tooth structure is necessary?
The crown with post should only be done on teeth with adequate tooth structure. The minimum amount of tooth necessary is roughly 2 mm of ferrule circumferentially. This is at least 2 millimeters of tooth structure that is left above the gum line.
The amount of tooth structure remaining affects the longevity.
Less than 2 mm of ferrule reduces longevity and prognosis.
If you have more than 2 mm of ferrule, the longevity and prognosis increases.
In summary, the more of your natural tooth you have left, the better the outcome will be. Yes, this procedure is meant to restore lost tooth structure but it still can't defy the laws of physics. Consequence of not having enough tooth left will lead to complications.
What to expect for procedure
We will describe in detail what to expect for a crown and post procedure using a prefabricated and a cast post. The prefab post can be done in one visit while the cast post requires two dental visits since it requires the lab to make it.
Crown with prefabricated post procedure:
Administer local anesthesia (optional).
Remove temporary restoration from root canal.
Prepare the post space with respective drills.
Cement the prefab post with core build up material.
Prepare the tooth for a crown.
Place a cord in the gums to push it away from the margins.
Take an impression of the tooth.
Pick a tooth shade.
Fabricate a temporary crown and cement it.
Crown with cast post procedure:
Local anesthesia is optional.
Excavate root canal temporary.
Prepare the post space.
Take an impression of the post space.
Send impression to lab for fabrication of cast post and core.
Place temporary and return to dentist in 2 weeks.
Remove temporary.
Permanently cement the cast post and core.
Prepare tooth for crown.
Pack cord into the gums for more accurate impression.
Take an impression.
Choose a tooth shade for the cap.
Fabricate a temporary and glue it in.
After the procedures above, you will need to return to the dentist once the permanent crown is made. That second appointment will be to try it in and cement it permanently.
Does it hurt?
The post with crown procedure should be painless since root canal treated teeth are dead and no longer have nerves in them. In other words, they are unable to feel any pain even if you drill on it.
If you wanted further reassurance, we rarely if ever numb our patients when we do this procedure. It is simply unnecessary since the tooth lacks a nerve and feels no pain. However, we may occasionally numb a nervous or anxious patient. The numbing is more of a placebo just to calm them down.
Complications
As with any dental procedure, complications can occur either during or afterwards.
Intra-operative complications:
Broken gates glidden or peeso reamer. When the post space is being prepared and the drill snaps becoming lodged in the canal.
Perforation. Drills can inadvertently drill through the root or furcation of the tooth thus rendering the entire tooth non-restorable.
Post-operative complications:
Crown keeps falling off.
How long does it last?
According to research, there is approximately a 1% failure rate per year for post and core restorations. Restorations were deemed as a failure if they fell off or if it fractured.
Other studies have shown somewhat similar results. A 5 year follow up study found that the overall success rate was 96% at the end of the five years. Overall, the longevity and success rate seem rather favorable for teeth restored with post and cores along with crowns.
Can it be redone?
If something happens to the post and crown, it can potentially be replaced with the same restoration. However, it really depends on what the cause for the need of replacement is.
When it can be replaced:
Only the crown fell off.
Damaged tooth cap.
Small cavity.
When it can't be replaced:
Broken post.
Fallen off crown with post attached.
Large cavity.
Typically catastrophic conditions are non-replaceable.
Cost
The average cost of a crown with a post is $1800 if you don't have dental insurance. The total fee is essentially equivalent to what an individual tooth cap plus what an individual post would be. There is no additional cost just because you're getting both procedures done together.
Procedure | Average Cost |
|---|---|
Post and core | $450 |
Crown | $1350 |
Post with crown | $1800 |
Cost with insurance
The average cost of a post and crown is $765 if you have dental insurance. Most PPO dental insurances have 80% coverage for the post and 50% coverage for the crown.
Procedure | Average Cost with Insurance |
|---|---|
Post and core | $90 (80% coverage) |
Crown | $675 (50% coverage) |
Post with crown | $765 |
However, you do need to watch out for your insurance's annual maximum. If you're using it for a root canal, post, and a crown you may come very close to maxing out your benefits for the year. If you max out, you will need to pay the difference out of pocket.
Pros & Cons
There are advantages and disadvantages to getting a post with your crown. The damaged and missing tooth structure after the root canal will need to be replaced so it may be thought of as almost necessary.
Pros:
Restores missing tooth structure.
Adds retention for the crown.
Considered as a "tooth saving" procedure.
Very strong since the post anchors the core material.
Cons:
Weakens tooth root.
Less conservative than core build up.
The metal can show through.
More costly than a core only.
With the exception of the glass fiber prefabricated posts, the rest of the materials are made of metal. This can be a cosmetic concern since the metal can show through the crown if it isn't thick enough.
Alternatives
An alternative to a post with a crown would be a core build up with a crown. In lieu of cementing a post attached to the core material, you can simply have a core build up without the post.
With recent advances in dental bonding, more and more dentists are moving away from using posts. Dentists are mostly doing core build ups without posts these days due to better dental bonding technology.
As a matter of fact, we actually stopped doing post procedures for the past few years. We've practically moved onto doing core build ups only after root canals for all of our patients. Dental bonding has really come a long way.
