Gary M. Radz, DDS, FACE

Restoration of endodontically treated teeth frequently requires the replacement of lost tooth structure as well as support and retention of the restorative material. Through the years, many different types of endodontic posts have been used to serve this need.

Current endodontic trends are to use conservative access, shaping, and flaring during the preparation of the tooth. Removing minimal tooth structure allows increased fracture resistance, providing a better long-term prognosis.

Because teeth have varying pulpal canal diameters and shapes, various prefabricated post systems have been introduced to accommodate the differences in each clinical situation. This has led to systems of multiple diameters, as well as parallel versus tapered posts.

Endodontic posts have been fabricated from various materials including gold, stainless steel, zirconia, and fiber-reinforced composite. There are volumes of papers discussing the benefits of each. Fiber-reinforced composites have become the most popular option in America because of an elastic modulus similar to dentin, its ease of use, and the potential for the post material to bond to tooth structure.

Designed to let the clinician adapt the fiber post to the canal flare with a vertically sliding (adjustable) conical sleeve. The sleeve is made of the same fiber-reinforced composite as the post and, when needed, slides on when the post is inserted, converting a pointed, parallel post into a custom-fitted post. Replacing cement with material of high mechanical properties increases the overall strength of the post/core.


Angelus recently brought the Splendor-SAP endodontic post system to the US. This system is a unique solution to challenges in current endodontic post kits. SAP stands for single adjustable post. It is created by using a 2-part system. The first part is a narrow, apically tapered fiber post like many other posts on the market. The second part makes this product unique. A sleeve provided with the posts and made of the same material can be placed over the post to allow for adaptation to varying diameters of coronal canal preparations

. This sleeve allows for better adaptation of the post system to the canal anatomy while increasing strength and retention. This ingenious design leads to a significant decrease in the inventory of post designs, sizes, and systems needed by the clinician.


The Catapult Education evaluators participated in the review of the post system in the first half of 2020. Each evaluator was provided with a Splendor-SAP kit that contained 5 posts and sleeves. Upon completion of the evaluation each doctor submitted a survey about their experiences with and opinions of the post system. There was no compensation to the evaluators for their participation in the review.


Within our evaluation team, ¾ currently place fiber posts, whereas the other ¼ place metal posts. Half of our evaluators performed endodontic treatment in their practices. Most of our evaluators cited flexural strength (associated with decreased likelihood of root fracture), ability to bond, and esthetics as primary reasons for choosing fiber posts.

When using the SAP system with the sleeve, most of our evaluators ranked the fit as good or excellent. When the system was used without the post (for narrow canals that did not require the use of the sleeve) our evaluators again rated the fit as good or excellent.

Half of our reviewers ranked the system as better than their current post system. Of the rest, all but 1 rated the SAP post system as “good as” their current system. Only 1 of our evaluation team rated their current post system as better than the SAP post.

Comments from evaluators included the following:

“Simple to use and simplifies my procedures.”

“Like having a universal size that can be used in a majority of cases.”

In general, our team was impressed with this unique and innovative clinical solution.


An endodontically treated tooth #21 presents with minimal coronal tooth structure and requires a post and core along with a full coverage crown to restore to function.

Using the drill provided with the Splendor-SAP kit, the endodontic filling material is removed as apically as possible without removing excess existing tooth structure.

The SAP post and sleeve are tried into place (

 and excess is removed with a diamond bur and tried to place again 

. The post and sleeve are treated as per manufacturer instructions.

The post space and remaining tooth structure are conditioned with a phosphoric etch along with a compatible bonding agent. For the cement, the author likes to use a dual cure composite resin buildup material (LuxaCore Z; DMG America) as the luting agent. The core material is injected into the post space. The post and sleeve are then inserted into the canal. Holding the post to place, the area is light cured for 30 seconds. Then the core material is injected around the visible post to create the core. This is then light cured for another 30 seconds, followed immediately by the final preparation 

A final radiograph demonstrates the conservative post placement that is now bonded to the tooth with the development of an adequate clinical crown to support the final restoration 

The author would like to thank Dan Ward, DDS, fellow Catapult Education evaluator, for sharing his photography of this case. Our Catapult Evaluation team was impressed with this product and is pleased to give it the Catapult Vote of Confidence.

Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.

Articles

Catapult Education evaluators are impressed with this new entry into the fiber post market from Angelus Dental.

Splendor-SAP From Angelus Dental: Unique and Versatile Post System

	One of the most common restorative procedures in a general dental practice is the single unit crown. Within the procedure workflow of most crowns is the fabrication of a provisional crown. The provisional crown is critical to provide protection of the prepared tooth, allow the patient to be able to function on the prepared tooth, provide esthetic temporary replacement of the tooth, and to maintain the interproximal and occlusal integrity while the final crown is being fabricated. The provisional crown is an important part of the final success of the crown procedure.

	As this is one of the most common procedures in general dentistry it is important that the dental team is efficient in its workflow. Efficiency not only increases productivity, it will also increase patient comfort and satisfaction.

	In the spring of 2019 members of Catapult Education were asked to evaluate the Matrix Buttons by Advantage Dental Products, Inc. The primary indication for the Matrix Buttons is for use as a pre-operative matrix for the fabrication of a provisional crown or bridge. Sixteen members of the evaluation team tested the Matrix Buttons in their practices for 4-8 weeks. During that time 78 provisional crowns and five provisional bridges were placed.

	The Catapult Education members were asked to evaluate the clinical performance of the Matrix Buttons as well as to consider the economics of including the product into their practices. 

	The Matrix Buttons is a thermoplastic “button” that when placed in hot water will become pliable and adaptable to the tooth/arch form that is being treated.

	Most of our evaluators used hot water from the tap that was then placed in a microwave (for 30-60 seconds), a few others used a traditional hot water bath that was already in the operatory.

	Once heated the Matrix Buttons will become clear. This is the indication that it is ready to be placed in the mouth and adapted. Half of our evaluators did this adaptation themselves, the other half designated it to their dental assistants. Three-fourths (75 percent) of our evaluators felt that they (or their assistants) were able to easily establish a good pre-operative record. Our evaluators were split on whether or not this part of the procedure saved time, and 63 percent acknowledged that there was a “learning curve” to using the material. Once this short learning curve is achieved, the placement and fabrication of the matrix can be easy and simple. One “trick” that has proven to be effective is to wet the fingertips of the operator’s glove before handling the Matrix Buttons. If the glove is dry the material can be sticky on the glove.

The provisional crown ready to be cemented to place (Fig. 7).

	The Matrix Buttons were used with a variety of different temporary materials. Four different types of temporary material were used by our team. All four materials worked well with the Matrix Buttons matrix. A large majority reported they were able to establish good margins, contacts, and occlusion when including the Advantage Dental Products’ solution as part of their technique. 

	As a group, our evaluators did not generally see a time savings using the Matrix Buttons as part of their workflow, but also noted that it did not add time. A majority did say that they felt inclusion of the product in their workflow would save them money.

	Lastly, our evaluation team did note that they could see the Matrix Buttons as having other clinical applications. Two of our evaluators that do a lot of sleep apnea appliances noted that the Matrix Buttons would be an excellent material to use for a morning mandibular positioning appliance. Another evaluator used the Matrix Buttons as a transitional bruxism device (similar to an NTI™). It was noted by our team that there could be a number of other clinical applications for the material.

	Overall, 80 percent of our evaluators stated that they would recommend the Matrix Buttons to a colleague. Based on our team’s clinical evaluation the Matrix Buttons were given the “Catapult Vote of Confidence”.


	Temporary crown Matrix Buttons from Advantage Dental Products are user-friendly: Just wet them in hot water for about 45 seconds to soften, mold them around the teeth, and blow air on them to harden for 20 to 30 seconds. They reportedly are ideal for any crown, inlay/only, or veneer restoration procedure, and can even be used for an anterior bruxing appliance or stretched over sensitive teeth for insulation. 

Matrix Buttons from Advantage Dental Products, Inc., for provisional crowns and bridges are evaluated and awarded the Catapult Vote of Confidence.
