Doug Kase
|
 ET’S
FACE IT: the discovery of a fractured post is depressing! It is not only
depressing and disappointing to the dentist whose hard work may not have
gone the distance for some unforeseen reason, but also to the patient,
who is likely to be upset over what feels like a wasted investment of time
in the dental chair and dollars out of pocket. The patient may lose
confidence in the dentist, especially if the failure occurs just a short
time after the endodontic procedure. Additionally if this post fracture
results in the loss of the tooth, the issues could become much more complicated.
All of a sudden the options of fixed bridges, removable dentures, implants,
or—even worse—a legal issue may loom overhead.
Explaining the Situation
A REASONABLE explanation to the patient is a good start toward rectifying
the situation. The reasons for post fracture can be multifaceted.
Recurrent decay, habits of occlusion, or unknown trauma are just a few
causes of post fracture. Whatever the cause, informing the patient
that all is not lost, especially the tooth, may take a potentially very
negative situation and turn it into a positive one with you as the hero
of the story. So how do we become the hero or heroine? We remove
the fractured post and save the day. |
FIGURE 1: Components of the
Ruddle Post Remover Kit. |
FIGURE 2: The slow-speed
bur is used to expose the top of the post.
FIGURE 4: The tap with protective
cushion is threaded over the prepared post head. |
Removing
a Fractured Post
THE REMOVAL of a fractured post can be done in a variety of manners.
We can drill them out with very fine high-speed burs under magnification.
The endodontic microscope is an invaluable aid during this procedure, especially
as we drill deeper into the root. Using a fine diamond ultrasonic tip improves
your ability to visualize the apical end of the post and facilitates its
removal by vibration. If enough of the post is accessible, an ultrasonic
tip can be used to vibrate the post out of the tooth without the use of
a drill.
We can also use an instrument called the Ruddle
Post Remover (Figure 1), which can provide an expeditious end to a tough
endeavor.
If there is enough of the post showing coronally,
the Ruddle Post Remover can extract it from the root with very little effort.
The Ruddle Post Remover can be used even if the remaining head of the post
is below the existing tooth structure, but use of this device becomes harder
and perhaps inappropriate the more submerged the head is. Additionally,
this instrument can be used only with passive posts, since the post will
be pulled out of the root and threads that engage dentin will interfere
with its function.
Using the Ruddle Post Remover
THE FIRST STEP is to use the included slow-speed bur to tunnel down
and expose the top of the post (Figure 2).
Once access to the post head is established, an
appropriate trephine bur (Figure 3) is used to shape the head into a corresponding
cylindrical shape.
Then a corresponding tap with a protective rubber
cushion (Figure 4) is reverse-threaded in a counterclockwise direction
over the prepared post head.
It is this tap that the post remover (Figure 5)
engages, and as it is tightened the remover extracts the post coronally.
An additional benefit to the reverse threads of the tap is on a threaded
post. By its use in a counterclockwise direction it can facilitate the
actual “unscrewing” of a threaded post since it cannot be extracted directly.
The end result is a happy patient due to a saved
case because we were able to save an abutment and perhaps save our “butts”
as well.
January-February 2001
 |
FIGURE 3: The trephine bur
is used to shape the head cylindrically.
FIGURE 5: Ruddle post remover
with tap and cushion in place and ready to use. |
