One of the discussions that invariably comes up at our CEREC hands on workshops is the question- do you place a post or not?  And if you do, when?   Lets look at the case below for example - how many of you would place a post here to restore this broken tooth?

I think the traditional method of treatment is to definitely place a post and use a build up in this tooth to retain the final restoration.  But if you look at what a post actually does, a post in this particular case may not be necessary.  The purpose of a post is to retain a build up.  It has nothing to do with directly retaining the final restoration.  It is the purpose of the build up to retain the crown.  So in the example above - is a build up needed?  What about a post?

In examining further, I would argue that a build up is needed to retain the crown for the broken tooth above. We certainly cannot rely on adhesion alone to hold whatever restoration is placed to replace the broken tooth.  There simply is not enough enamel left and if there is no enamel, then long term, I tend not to trust adhesion alone to retain the restoration. In a word, if we don’t have enamel to bond to, my suggestion its that you incorporate as much traditional retention or resistance form as possible into the preparation design to keep the restoration in place.  If there is a ton of enamel (a facial prep for a veneer for example), then we can rely on adhesion and not have to worry as much about retention and resistance form.

To take it one step further, we agree that we need a build up - do we need a post to retain our build up?  I would say no.  Posts are being used less and less frequently today than compared to the past.  Today, the post in this situation would not offer any benefits if we can get the build up to stay.

When I used metal screws as a post, I would agree to limit the use. With the advent of fiberglass for our post material, it changes the force distribution. I like them a lot for bi's and centrals.