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

Post crowns, also known as post-and-core crowns, are a type of dental restoration that can help you restore your root-canal-treated tooth.

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

It consists of two parts: a post-and-core that fits inside the root canal and a regular crown that caps the tooth.

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

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

Think of the restoration like a building: a regular crown is a single-floor structure, while a post crown has two floors.

• A regular crown is placed after the tooth is drilled or trimmed. The trimmed part of the tooth that supports and holds the crown is called the core.


• A post crown has two parts (or "two floors"): the post-and-core and the crown itself. It’s commonly used for root canal-treated teeth that are too weak to hold a regular crown on their own.

Here are the typical steps to restore a tooth after root canal treatment with a post-and-core crown:

1. Post placement: The post is fitted into one of the root canals to provide better hold and retention for the future crown.


2. Core: Placed on top of the post (above the gum line), the core acts as the foundation for the crown.


3. Crown: Once the post-and-core is in place, a crown is fitted on top, restoring both function and appearance.

There is also another type of restoration called a one-unit post-crown, where the post and crown are fused together into one piece. One example is the Richmond crown, which can be used when there isn't enough space for a traditional post-and-core 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 alone will likely shorten its life to one year or less. That's exactly when you need a post-crown.

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

The typical situations are when the cavity has damaged more than half of the root-canal-treated 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-and-core will provide the foundation needed for the crown.

Here's what a post-crown can do:

• Strengthen the restoration and increase its lifespan
• Restore the shape, appearance, and function of the tooth
• Improve the hold of the crown

However, just because you've had a root canal doesn't necessarily mean you need a post. If your tooth is still strong, 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. The decision to place a post-crown often depends on factors such as:

• The 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 lifespan: 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. Here are a few reasons why a tooth might need to be extracted:

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

What are the types of post crowns?

There are many different techniques and post systems available, each with its own pros and cons. The best option depends on a few things—like whether it’s a front or back tooth, and how severe the damage is.

Post Types

1. Post-and-Core that can be done in one visit (Prefabricated)

These post systems come in standard sizes and can be placed directly into the root canals without needing lab work. That means the procedure can be done in a single visit, saving you time.

Once the post is in place, your dentist manually builds up the core, usually using a tooth-colored composite material.

Posts can be made from either metal or non-metal materials:

• Metal posts are strong but less aesthetic due to their dark-silver color. They can also be a bit harsh on the tooth because of their stiffness.


• Non-metal posts are made from tooth-colored materials, making them more natural-looking and cosmetic choice for front teeth.
  They are more flexible and help distribute chewing forces more evenly. This makes them gentler on the tooth and reduce the risk of root fracture.
  Common non-metal materials include zirconia, glass fiber, and quartz fiber.

2. Post-and-Core that require lab work (Custom-made)

These take more time because they involve an extra step. Your dentist will take an impression of your tooth, which is then sent to a lab to make the post-and-core.

The post-and-core is cemented, then another impression is taken to prepare the crown.

They are usually made from metal, but other techniques offer cosmetic ceramic options.

Because ceramic blends in with natural teeth, it's especially suitable for front teeth where appearance matters most.

A custom post-and-core is needed instead of a prefabricated one when the tooth is severely damaged.

Dental Crown Types

1. Metal Crowns:

Metal crowns are made entirely of metal, such as gold or platinum, which makes them very strong and durable. They’re best suited for back teeth that don’t show when you smile but need extra strength to handle chewing pressure.

2. All Porcelain Crowns:

All-porcelain crowns are made entirely of tooth-colored ceramic, offering the best aesthetic results and making them ideal for front teeth.
Back teeth can also benefit from high-strength ceramic materials like zirconia. However, since they sustain much more pressure, metal crowns are often the better choice—especially for people who grind their teeth (bruxism).

3. Ceramic-Metal Crowns:

Ceramic-metal crowns are a combination of the two types above. They have two layers: a metal inner layer for strength and a porcelain coating for a natural, tooth-colored look. 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 how well you care for it.

According to a study, the average survival time for custom-made metal posts is 11.8 years. Non-metal posts can last slightly longer, on average 12 years.

Another study of 112 teeth treated with root canals found that after a 10-year follow-up, post-and-core crowns had a survival rate of 83.03%.

What are the risks associated with a post-crown?

As with any dental treatment, post-crown procedures carry a few risks. These depend more on the remaining structure of your tooth, as well as the technique and protocol used.

One study showed that post-crowns have a failure rate of around 10%. The three most frequent complications are:

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

1. Post loosening:

The post may become loose over time due to many factors, such as the type and size of the post, the material used for bonding, and the way the tooth was prepared.

Biting hard objects or grinding your teeth can also weaken the bond over time, causing the post to become loose.

A loose post can reduce the stability of the restoration and may even cause it to fall out completely.

2. Root fracture:

The main risk of placing a post inside a root canal is that it thins and weakens the root walls, making the root more likely to crack or break.

A fractured root can lead to pain, infections in the tooth and gums, abscesses, and ultimately tooth loss.

3. Root canal complications:

Before placing the post, your dentist will clean and drill out part of the old root canal filling to make room for the post.

This step can sometimes damage the root or leave gaps where bacteria can enter and cause an infection.

If this occurs, it can lead to pain, a gum abscess, and treatment failure.

Takeaway

A post-and-core crown is an excellent option to save a root-canal-treated tooth that might otherwise need to be removed. It’s often necessary when the tooth is too badly damaged to support a simple filling or crown.

To protect your teeth and help your restoration last longer, maintain good oral hygiene, avoid biting on hard objects, and make sure to visit your dentist regularly for check-ups and cleanings.