Do you need a post-crown for your tooth? Pros, Cons, Types, and More

dental post crown
Post crowns, also known as post and core crowns, are a type of dental restoration that can help you restore your smile and your oral health after a root canal treatment.

They are composed of two parts: a post-core that goes inside the root canal and a regular crown that covers the tooth.

Sometimes, a normal filling or crown is not enough to rebuild the tooth after a root canal, and that's when a post crown comes in handy.

In this article, we will learn what post crowns are, why you might need them, and what types are available.

What is the difference between a post crown and a regular crown?

post and core crown
A post crown and a regular crown are both types of dental restorations that cover and protect damaged teeth. However, they have different structures and purposes.

To understand the difference, imagine the restoration as a building. The regular crown has only one floor, while the post crown has two.

A regular crown is placed after the tooth is prepared by removing decay, old fillings, and unsupported parts. The remaining tooth structure is called the core, and it provides a base for the crown to fit over.

A post crown has two parts (two floors). It is used when the tooth has had a root canal and has very little or no core left.

In that case, the best option is to place a "post" into one of the root canals to strenghten the tooth and provide better hold and support. Then, on the top portion of the post above the gum line, a core is built up with a material to create a base for the crown. Finally, the crown fits over the post-core like a regular crown.

There is also another type of restoration called a single-piece post and crown system, where the post and crown are fused together into one piece. This is also known as a Richmond crown, and it may be used when there is not enough space for a post-crown.

Richmond crown

Richmond crown

When do you need a post crown?

Dental crowns can last up to 15-20 years if made properly. However, if the tooth is already severely damaged, placing a crown will shorten its life to one year or less. That's where the post-core comes in handy.

A post-crown is usually recommended when the tooth has lost a lot of its natural structure due to decay, trauma, or root canal treatment.

The typical situations are when the cavity has damaged more than half of the tooth. Placing a regular crown or a filling would cause it to come off. Another common situation is when a fracture has occurred at the gum level. A post-core will provide the base needed for the crown.

A post crown can help to:

  • Strengthen the tooth and prevent it from cracking or breaking
  • Restore the shape, appearance, and function of the tooth
  • Improve the hold of the crown
  • Increase the lifespan of the restoratio

However, just because you've had a root canal doesn't necessarily mean you need a post. Depending on your situation, a dental filling or crown might actually be a better choice. These options are simpler, easier on your tooth, and more affordable.

When is post-crown not the best solution for you?

A post crown is not always necessary or suitable for every tooth. Some factors that may influence the decision to get a post-crown are:

  • The amount of remaining tooth structure: If the tooth has enough healthy enamel and dentin to support a filling or a regular crown, a post crown may not be needed.

  • The condition of the root canal: If the root canal is too narrow, curved, or calcified, it may be difficult or impossible to place a post without damaging the tooth or the surrounding tissues.

  • The risk of infection: If the root canal is not properly sealed or cleaned, bacteria can enter and cause inflammation or abscess. A post may increase this risk by creating a pathway for bacteria to travel along.

  • The cost and durability: A post crown is usually more expensive and complex than a filling or a regular crown. It may also require more maintenance and adjustments over time.

Sometimes, a tooth is just beyond repair - it can't stay in your mouth and has to be removed. But don't worry, your dentist can help you figure out what to do next. They might suggest a bridge or implant to replace the missing tooth. Here are a few reasons why a tooth might need to be pulled:

  • It's decayed or broken beyond repair.
  • There are defects in the roots or canals that prevent a post from fitting properly.
  • There's advanced bone loss in the jaw.
  • The tooth is too loose or wobbly.
  • There's a persistent infection that just won't go away.

What are the types of post crowns?

When it comes to post-cores and dental crowns, there's no one-size-fits-all solution. Your dentist will assess your teeth to determine the best type of post-core and crown for you.

Post-core types:

1. Non-Metal Post:

Non-metal posts are usually made directly in the mouth and do not require any lab work, making them less time-consuming. They are also more aesthetically pleasing than metal posts and gentler on the tooth. Additionally, they distribute chewing forces evenly over the tooth, reducing the risk of root fracture. However, non-metal posts are more brittle and require a larger supporting tooth structure. Among the different types of materials are zirconia, glass fiber, and quartz fiber.

2. Metal Post:

Metal posts require an extra lab step, which increases the procedure delay. They are stronger than non-metal posts but less aesthetically pleasing. Metal posts also put more tension on the root, increasing the risk of fracture. They are a good option if the remaining tooth structure is severely weakened and requires solid protection.

3. All Ceramic Post:

Ceramic is a material with optical properties similar to natural teeth, making it a good option for improving the aesthetic appearance of the restoration. All ceramic posts are used for this purpose, especially for front teeth, which are visible when you smile. They can blend in with natural teeth, providing an aesthetically pleasing result.

Dental crown types:

1. Metal Crowns:

Metal crowns are made entirely of metal, such as gold or platinum, making them durable in the mouth. However, they are less aesthetically pleasing. They are ideal for back teeth, where appearance is not a significant factor and they can withstand the chewing forces.

2. All Porcelain Crowns:

All porcelain crowns are the most aesthetic and blend well with natural teeth. Therefore, they are more suitable for front teeth. However, porcelain is more fragile than metal, which makes them less ideal for back teeth or in cases of teeth grinding.

3. Ceramic-Metal Crowns:

Ceramic-metal crowns consist of two layers: a metal substructure and a porcelain coating. The metal provides strength, while the porcelain gives them an aesthetic appearance. They can be suitable for both front and back teeth.

The success rate of a post crown

How long a post crown will last depend on many factors, including how severely the tooth was damaged, the material used, the tooth involved, and your maintenance.

According to a study, the average survival time for the metallic post is 11.8 years. Non-metallic posts last slightly longer, on average 12 years.

Another study of 112 teeth treated with a root canal showed that after a 10-year follow-up, their survival rate was 83.03%.

What are the risks associated with a post-crown?

As with any dental treatment, post-crown procedures carry risks. They depend more on the remaining structure of your tooth, as well as the techniques and protocols utilized by your dentist.

One study suggests that post-crowns have a failure rate of approximately 10%. The three most frequent complications associated with posts and cores are:

  • Post loosening (5%),
  • Root fracture (3%),
  • Caries (2%).

1. Post loosening:

The post may become loose over time due to various factors, such as the type and size of the post, the material used to bond it to the root canal, and the way the tooth was prepared. A loose post can compromise the stability and retention of the crown, and may even fall out completely. To prevent this, your dentist will choose the most suitable post for your tooth and use a strong adhesive to secure it.

2. Root fracture:

The post also has a downside: it weakens the root of the tooth and makes it more prone to fracture.
The thicker and longer the post, the more stress it puts on the root when you bite or chew.
The type of post also matters: metal posts tend to concentrate the force on one point, while non-metal posts distribute it more evenly along the tooth.
A fractured root can cause pain, infection, and tooth loss.

3. Root canal complications:

Before placing the post, your dentist will need to clean and shape the root canal thoroughly to remove any bacteria or debris. However, sometimes this process can damage the root canal or leave some space where bacteria can enter and cause an infection.
This can lead to inflammation, pain, abscess formation, and bone loss around the tooth. To avoid this, your dentist will use sterile instruments and materials and fill the root canal completely with a sealant.