Basic Research—Technology

Comparison of the Efficiency and Effectiveness of Various

Techniques for Removal of Fiber Posts
Matthew Lindemann, DDS, Peter Yaman DDS, MS, Joseph B. Dennison DDS, MS, and
Alberto A. Herrero, DDS

Abstract
A study was conducted to determine the efficiency and
effectiveness of several techniques for fiber post re-
moval. Four groups of 20 mandibular premolars were
T he restoration of endodontically treated teeth frequently requires the use of a cast or
prefabricated post and core system. Recently, there has been an increased use of
fiber posts and composite cores because of their mechanical and esthetic properties
endodontically treated and obturated. Post spaces were that allow them to blend with the permanent restoration. Studies have shown greater
prepared for the following post systems: ParaPost XH, integrity and less stress accumulation within theses systems compared to traditional
ParaPost Fiber White, Luscent Anchors, and Aestheti- systems (1, 2). These mechanical advantages are maintained as long as fiber post
Plus. After cementation, 10 posts of each group were systems are not contaminated with oral moisture and that fiber integrity is not disrupted
removed with their corresponding manufacturer’s re- during post trimming preparations (3, 4). In addition to these advantages over tradi-
moval kit and the other 10 removed with diamond burs tional metal posts, it has been claimed that these posts are easier to remove to allow
and ultrasonics. Removal times were recorded and the access to the root canal space in case of a failed post system or endodontic treatment.
teeth were sectioned vertically and microscopically an- The latest generations of fiber posts have elastic moduli more similar to the
alyzed for removal effectiveness based on a 0 to 5 point modulus of elasticity of dentin (4, 5). A post with a modulus of elasticity greater than that
scale. Removal kits removed Luscent Anchors the fast- of dentin can create stress at the tooth/post interface, possibly resulting in post sepa-
est (mean ⫽ 3.9 min) and most effectively (mean ⫽ ration and failure (7). Better dentinal bonding techniques have also been developed to
2.6), while Aestheti-Plus posts were removed the slow- ensure maximal adhesion of the post system (5). However, improved bonding of the
est (mean ⫽ 7.3 min) and least effectively (mean ⫽ fiber post to the canal space may cause a problem for easy removal. Most fiber post
3.4). Diamonds and ultrasonics required an average of removal systems consist of an initiating pin pilot drill followed by a sequence of drills
10 additional minutes for each fiber post system re- that essentially hollow out the posts. This disrupts the internal integrity of the posts, yet
moval, yet removal effectiveness improved half a point. the peripheral portion remains solidly adhered to radicular dentin.
The results suggest recommended removal kits were Recent studies have investigated the removal time of several manufacturers’ fiber
significantly more efficient, while diamonds and ultra- posts. In general, these studies report that fiber posts can be removed in a relatively
sonics were more effective. Removal kits could be short time (6, 7). However, many clinicians have found difficulty in completely remov-
enhanced with subsequent ultrasonic instrumentation ing fiber posts. Thus, there appears to be a gap in knowledge between the results of
to remove remaining fibers and cement. previous research (and manufacturers’ claims) and the challenges that clinicians en-
counter with removal of fiber posts. The purpose of this study was to determine the
effectiveness (how thoroughly a post is removed) and efficiency (how quickly a post is
From the University of Michigan, Ann Arbor, Michigan. removed) of various techniques for removal of fiber posts under standardized condi-
Address requests for reprint to Dr. Matthew Lindemann, tions.
University of Michigan, 4252 S. Linden Rd., Flint, MI 48507.
E-mail address: [email protected].
Copyright © 2005 by the American Association of Materials and Methods
Endodontists
Eighty extracted single-rooted mandibular premolars with similar lengths and
widths were used in this study. A diamond disc model trimmer was used to remove the
clinical crown 1 mm above the CEJ, perpendicular to the long axis of the root. The
prepared teeth were stored in a 0.2% sodium azide solution until used.
The root canals were prepared with .04 ProFile rotary endodontic files (Dentsply/
Tulsa Dental Products, Tulsa, OK) and a 2.5% sodium hypochlorite solution. The filling
procedures utilized the Spartan Obtura (Obtura/Spartan, Fenton, MO) with Roth’s
sealer to obturate the canal system. The gutta-percha fillings were removed with a #3
Gates Glidden drill (Dentsply/Maillefer, Ballaigues, Switzerland) to a depth of 8 mm for
post space preparation.
One titanium alloy post and three fiber post systems were used: Group 1) ParaPost
XH-control (Coltene. Whaledent, Mahwah, NJ), group 2) ParaPost Fiber White (Col-
tene/Whaledent, Mahwah, NJ), group 3) Luscent Anchors (Dentatus, New York, NY),
and group 4) Aestheti-Plus (Bisco Dental Products, Schaumburg, IL). Twenty teeth
were prepared for each post. The most common post size among the different compa-
nies, 1.5 mm, was chosen to maintain standardization. All post space preparations
followed manufacturers’ instructions. Dentin was etched, rinsed, and dried with oil free
air. ParaPost Cement (Coltene/Whaledent, Mahwah, NJ), a self cure resin cement, was

520 Lindemann et al. JOE — Volume 31, Number 7, July 2005

 Basic Research—Technology
used for all cementations. Subsequently, the teeth were individually 0.05, for the type of method employed for extraction of each fiber post
wrapped in water moistened paper towels and stored for 24 hr in indi- type for both time and effectiveness. The post hoc Tukey tests indicated
vidual plastic bags. that the removal kits required significantly less removal time for each
Ten posts in each group were removed using their company’s post type (p ⱕ 0.05). However, only the group 1 removal kit was
corresponding post removal system (method 1) and the other 10 posts significantly more effective in eliminating residual material from the
were removed using a combination of diamond burs and an ultrasonic canal walls. Diamonds and ultrasonics were more effective in group 2
scaler (method 2). Method 1 for ParaPost XH utilized the Ruddle Post and there were no significant differences among methods in either
Removal System-PRS (Analytic/Sybron Dental Specialties, Glendora, group 3 or 4. When individually evaluating method 1 and 2, there were
CA) with water. All post removal procedures were performed according statistically significant differences in mean time and effect among the
to the manufacturers’ instructions. different post types at p ⱕ 0.05. For method 1, group 1 was slower than
Method 2 used #2 and #3 diamond burs (Brasseler, USA) to sec- all other groups, and group 4 slower than 2 and 3. Method 2 only found
tion the post at the post tooth interface to allow for adequate space for group 1 to be significantly slower than all other groups. For method 1,
the ultrasonic tip to access the tooth post bonding interface. CT-4 and group 1 was more effectively removed than all other groups, and 3
SP-1 ultrasonic tips were used to break the bonding interface and vi- better than 2 and 4. Method 2 only found group 3 to be more effectively
brate out the posts. If this failed the diamond burs were used by the removed than group 1.
investigator to remove the remnants of the fiber post.
Using a stopwatch, each extraction procedure was timed as a rel-
ative measure of the efficiency of the removal procedure. After post
Discussion
removal the teeth were vertically sectioned with a slow speed diamond It has been suggested that one of the advantages of fiber posts is
water saw. Removal effectiveness was assessed under a light microscope their ease of retrieval. This investigation determined that removal kits
as accurately and objectively as possible despite the operator and eval- are necessary in order for the clinician to maintain efficiency; however,
uator being the same individual. The following five point scale was used: removal effectiveness results may be better achieved through ultrason-
1. Only dentin can be seen after post removal ics and diamond burs.
2. Only cement can be seen after post removal The ParaPost XH was included as a control to determine whether
3. ⬍25% of the fibers or metal are left after post removal fiber post removal was easier and more effective than removing con-
4. 25 to 50% of the fibers or metal are left after post removal ventional metal or titanium posts. If diamonds and ultrasonics (method
5. ⬎50% of the fibers or metal are left after post removal 2) were applied, then fiber post removal was far quicker. Method 2
requires the clinician to grind metal posts and trench them circumfer-
A two way ANOVA test determined whether an interaction existed entially to fracture the bonded interface and vibrate the posts loose.
between the type of extraction method applied to a given post type for 1) Unfortunately this resulted in significant radicular dentin loss to the
time and 2) effectiveness. One way ANOVA and Tukey tests were used to point of possible perforation or initiation of vertical fractures. It was
determine where significant mean differences existed for extraction also important to proceed slowly while grinding through metal posts to
time and extraction effectiveness among all the posts and removal meth- avoid excessive heat generation. Fiber posts lack these problems be-
ods. Finally, t-Tests were used to determine differences in means for cause of their composition, yet removal of all posts resulted in slight
time and effectiveness between each post type’s suggested removal canal enlargement.
method and the older accepted method. When method 1 was employed, the Ruddle PRS used on metal
posts was more effective than fiber post removal kits and only took an
Results average of 10 more minutes to use. In all cases, only cement remained
The means and SEMs for the removal and effectiveness are pre- in the canal with the ParaPost XH, whereas fiber post removal kits
sented in Fig. 1. Two way ANOVA found a significant interaction, at p ⱕ removed the majority of the post, but cement and fibers were left after

Figure 1. Mean post removal times (PRT) and mean removal effectiveness (RE).

JOE — Volume 31, Number 7, July 2005 Fiber Post Removal 521
Basic Research—Technology
post extraction. This is probably a result of the difficulty in maintaining if fiber posts are removed with kits followed by subsequent ultrasonic
the removal drills in a central orientation when hollowing through the instrumentation.
post. Of particular note, fiber posts were removed only with their cor-
responding removal kit and without the aid from ultrasonics or dia- References
monds. It would be likely that better removal effectiveness could be 1. Reid LC, Kazemi RB, Meiers JC. Effect of fatigue testing on core integrity and post
obtained with subsequent use of ultrasonic efforts after the removal kits. microleakage of teeth restored with different post systems. J Endod 2003;29:125–31.
In most post removal situations, the dentist is generally confronted 2. Eskitascioglu G, Belli S, Kalkan M. Evaluation of two post core systems using two
different methods (fracture strength test and a finite elemental stress analysis).
with a fiber post of unknown origin. In these instances, all of the removal J Endod 2002;28:629 –33.
kits tested would be ineffective since they are specifically designed by 3. Mannocci F, Sherriff M, Watson TF. Three-point bending test of fiber posts. J Endod
manufacturers for their own post systems. Thus, the clinician many 2002;27:758 – 61.
times resorts to ultrasonics and burs that may not be necessarily de- 4. Grandini S, Balleri P, Ferrari M. Scanning electron microscopic investigation of the
surface of fiber posts after cutting. J Endod 2003;28:610 –12.
structive but do distort the canal shape and size. A universal fiber post 5. Vichi A, Grandini S, Ferrari M. Comparison between two clinical procedures for
removal system, similar to the Ruddle PRS, would be beneficial to allow bonding fiber posts into a root canal: a microscopic investigation. J Endod 2002;28:
preferential removal of any fiber post while maintaining canal shape and 355– 60.
size. 6. Gesi A, Magnolfi S, Goracci C, Ferrari M. Comparison of two techniques for removing
fiber posts. J Endod 2003;29:580 –2.
Fiber post removal speed was best obtained with removal kits and 7. Cormier CJ, Burns DR, Moon P. In vitro comparison of the fracture resistance and
fiber post removal effectiveness was best achieved with ultrasonics and failure mode of fiber, ceramic, and conventional post systems at various stages of
diamonds. It is possible that improved performance might be obtained restoration. J Prosthodontics 2001;10:26 –36.

522 Lindemann et al. JOE — Volume 31, Number 7, July 2005