Posts – when it all goes wrong! part 2: post removal techniques

The previous article in this series discussed the variety of post systems that are available on the dental market and the incidence and reasons for failure of teeth that have been restored with posts. It also discussed the treatment options available for the management of such failures and highlighted the importance of carrying out a thorough assessment to aid with treatment planning. Post removal is often indicated, and this article will describe the various techniques and systems available and their indications.

The preparation required prior to post removal will vary depending on what type of post is present and what technique for removal is going to be used. The tooth should be isolated (preferably with rubber dam) to prevent the inhalation or ingestion of post fragments or instruments during the procedure and to maintain an aseptic working environment.

Informed consent must be obtained from the patient and other possible treatment options discussed. In cases of endodontic failure, these may include peri-radicular surgery, extraction, or monitoring of a radiographic lesion, and the advantages and disadvantages of each approach must be discussed. If post removal is necessary because of a fractured post, the alternatives are limited to keeping the root as an overdenture abutment, retaining a core with dentine pins (a compromise with a poor long term outcome) or extraction.