A prefab post and core is a restorative dental procedure which uses a prefabricated post with core build up material to replace lost tooth structure. It is done after a root canal to create a tooth shape that is conducive to fitting a crown over it. Without it, the tooth cap may not fit as intended.
Table of contents:
Overview
The purpose of a prefab post and core procedure is to rebuild the damaged tooth structure from decay and the root canal. It is required because without it, the dental crown may not fit properly over the weakened tooth.
This particular post and core procedure utilizes a prefabricated post along with core build up material to restore all of the missing tooth structure.
Prefab post. A pre-made pin or screw looking prosthetic that gets inserted into the tooth canal. It may be made of various types of material but their purpose remains the same, which is to add retention for the core build up.Tooth did not have a root canal
Core material. The core material is typically made of dual cure composite resin and it gets placed over the entire post. It's purpose is to rebuild all of the damaged, lost, and missing tooth structure.
Material
The pre-made posts can be made of various materials. There are the traditional metal ones and also the more modern fiber posts. The fiber ones can be made of fiber glass or mixed with resin. They are white or see-through in color so they tend to be more aesthetic.
Types of material:
Titanium
Stainless steel
Gold plated
Fiber
There shouldn't be a difference in cost since dentist don't really up charge for any of the material. Although if you choose a cast post and core, it does cost more but that is a completely separate procedure.
Type of post system
The two types of systems for prefabricated posts are cylindrical shaped or screw shaped.
Cylindrical shaped post. These posts are either tapered or parallel. They are inserted into the post space of the canal passively.
Screw shaped post. These posts look like a screw and they are inserted into the canal by screwing them in. Essentially they are put into the post space actively.
X-ray of a screw post
The radiograph above shows what a screw type of post looks like on a dental x-ray. It literally looks like a screw and is easily discernible to even the untrained eye.
When it's needed
A post and core that is prefabricated is only required after a root canal but only if it meets certain requirements.
Missing enough tooth structure. It has to be missing at least one axial wall of the tooth. What we mean by axial wall is if you imagine a cube and at least one side of it was missing.
Not missing too much tooth structure. If the tooth is missing ALL of its axial walls, it may be pointless to even do this procedure. That tooth has a poor restorative prognosis and should be extracted instead!
Contraindications
Tooth is barely missing any tooth structure. If your tooth has no walls missing, it may be unnecessary to do this procedure because a core build up will suffice.
Tooth has no more axial walls left. If there is barely any of the tooth left, it may be pointless to restore it. You should think about extracting and replacing with an implant.
Tooth did not have a root canal. Any post and core procedure requires putting the post down into the tooth's canal. That is essentially where the nerve is so if your tooth is still alive and never had a root canal, you can't do this procedure.
Procedure expectations
The entire prefab post and core appointment can be done in a single visit and it takes 30-45 minutes at most. It is also typically unnecessary for any numbing or local anesthesia.
What to expect during the treatment:
No anesthesia needed unless you request for it.
Remove temporary filling material.
Prepare the post space by drilling into the canal with increasing sizes of gates glidden, peeso reamers, and post drills.
Clean the tooth and apply bonding.
Cement the prefab post with core material.
Continue expressing the material until core is completely built up.
Light cure and wait for the material to set.
Once the core has fully hardened, it is ready to be adjusted and polished. At this point in time, you are ready to proceed with the crown appointment. Some dentists like to prepare for the crown during the same which while others like to do it at a separate appointment. If it is the former, you should expect the appointment to take an extra 30-45 minutes.
Aftercare
There are no special aftercare instructions after this procedure. The tooth should shortly receive a crown over it so you just take care of it as if it was any other tooth in the mouth.
Brush it twice a day for two minutes each.
Floss before bed.
Minimize sugar intake so you don't get a cavity.
Keep up with routine dental check ups every 6 months.
Aside from that, you can eat with it, chew with it, and speak with it.
Complications
Every procedure comes with risks and benefits so this one is of no exception. Mishaps can occur and studies have demonstrated that there is a chance for restorative failure.
Potential complications:
Tooth fracture. Different post materials will have different fracture rates. Studies show that the stainless steel posts had a worse fracture prognosis when compared to the fiber.
Metal show through. If you get one of the metal posts put in, it may make covering up the color difficult. The fiber post is the most aesthetic since it is see through.
Crown falls off with post attached. If there isn't enough natural tooth structure, this procedure may not be retentive enough to retain the crown. Sometimes the entire crown with the post can fall out while you're eating.
Tooth decay. This procedure does not completely replace all of your tooth. Your natural tooth structure that is next to the build up can still become decayed.
Basically you should be aware that things can go wrong.
Cost
The average cost of a prefabricated post and core is $374.01 and that is without insurance. It can be as low as $280 and as high as $504 but it depends on the cost of living in your area. These statistics are from the ADA survey of dental fees. It is not all inclusive because they're based on dentists who did respond to the survey.
Cost with dental insurance
The average cost of a prefab post and core with dental insurance is $74.80 if you have 80% coverage. That is the most common percentage insurance coverage which we see with all of our patients. However, we have seen some with only 50% coverage as well but it depends on your specific plan.
The dental billing code for this treatment is D2954.
Alternatives
An alternative to doing a prefabricated post and core would be either a cast post and core or simply a core build up.
Cast post. The cast post procedure requires two visits because the dental lab needs to make it. The biggest downside would be its aesthetics since it is made of metal.
Core only. Due to advances in dental bonding technology, a core build up is becoming the preferred way to restore the tooth after a root canal. It's main benefit is that it does not require post space preparation which can save a lot of time during the appointment.
Attributes | Cast post & core | Prefab post & core | Core build up |
|---|---|---|---|
Number appointments | 2 visits | 1 visit | 1 visit |
Strength | Very strong | Good | Good |
Aesthetics | Poor (metal) | Depends on material | Best (metal-less) |
Cost | $430.52 | $374.01 | $307.55 |
Outlook
As long as you take care of your teeth, this procedure should last a very long time. Studies have shown that over a 5-15 year period, there is about a 1% increase in failure rate per year. Those are some very favorable odds according to our dentists in Long Island City.
Nonetheless, it would still help if you minimize the amount of hard foods that you eat. Biting into ice cubes or using your teeth to open beer bottles will increase the chances of adverse events occurring.
