Post and Core

I think a lot of people have doubts about this procedure so hope this post helps! Let me know if I got anything wrong, and I will change it. I was assisting during this procedure. NOTE: compare with Dr. Broome's write-up in the UAB SOD Standard Operating Procedures handbook. He does a good job of walking through the procedure step-by-step.

 What Do I Do First?

• First off, you are going to give anesthesia.  The tooth you are working on has had a root canal, but the gingiva around it will still be sensitive. 
• Put on a rubber dam. We did an anterior tooth, so we used an anterior clamp. When we were done putting on the dam, it looked like this:

•  Now you are ready to remove the cavit or IRM or whatever. Use a slow speed round bur. 

 Preparing the Canal

•  Get your working length! - Do this by pulling up the endo note. Pull up the patient's yellow card on Salud. Go to EDR Summary --> Endo. And then I think you find the procedure and then double click on it. You may want to consult your faculty on this step. You need the WL & the reference point. 
•   Prep the Canal - remember that there needs to be at least 4-5mm of gutta percha left in the canal. Our WL was 18mm, so we first prepped the canal to a length of 12mm. You can use either:
• Gates Glidden burs - whichever one comfortable fits into the canal
• Post sizing drill (AKA endo rotary burs). Start with the smallest (black) and move up if needed.

• We actually didn't use the GG burs. Our resident told us we just needed to use the rotary post-sizing bur. You attach these to your latch slow-speed handpiece. Turn the speed down so that you don't tear up the canal. Also, make sure you are parallel with the tooth and try to only remove GP. Minimize touching the bur to the canal walls because we don't want the prep to get wider.
• Remember to put a silicone stopper on your bur and set it to the desired preparation depth (e.g. 12mm)

• Take a radiograph - once you think you are the right depth, take a radiograph without the bur in it to make sure you have removed all the GP and are at a good length. We were not far enough so we ended up extending the prep to 15mm, retaking another radiograph, and then proceeding to the next step. 

Preparing the Post

• Post Selection - whatever post-sizing bur you ended with will correspond to the post that you should use. Remember this picture: 

•  Put the silicone stop on the post to the length that you prepped the canal. Wipe the post with alcohol and then make sure that it will seat all the way to the bottom of the prepped canal. Broome says to coat your post with adhesive for 20 seconds and then air dry it. Seat it back into the canal until you are ready to begin cementation.
• Here is your post and core set up:

•  Left to right: alcohol pad, etchant, water syringe, microbrush, L-pop adhesive, microbrush, Rely-X, curing light, and gun for the composite core build-up.

• And here is the included instruction sheet:

A few other notes

• Make sure you fill the water syringe with the water that we have connected to our chair. Don't use water from the sink.
• Ask the faculty where they want you to cut the post off at. For our patient, we left it a little longer due to the amount of missing tooth structure.
• You will need some flowable composite as well as the normal Z100. Start with the flowable and then move to Z100. The faculty may just tell you to fill the whole thing with flowable. 
• Don't forget to etch, prime, and bond for the composite like always. 

If you have anything to add or any questions, let me know!
- Joe