Fiber post with core build up- when the right bonding technic is done suits most of the cases- saves time and also more esthetic

BUT, the studies on fibre posts and cores are very low on evidence from a longevity point of view. Long term studies still show that the cast post and core survives long after prefabricated posts with composite cores and there simply aren't enough long term studies on fibre posts with composite or resin reinforced cores. Perhaps it's not the post that's the problem, but finding sufficient retention for the core. When that is compromised then case selection is vital. With comparatively new techniques, patients must be informed of the lack of long-term studies and if their occlusion is unfavourable they should be given the choice, one that is informed by the relative risks vs costs. We still advocate cast posts and cores, even if they are more expensive: they may not be in the long run!

The presence of a ferrule is by far the most important prognostic factor for endodontically-treated teeth. I believe that a compromised ferrule is a good reason not to restore the tooth, but rather extract and replace with an implant, if possible.

The cast post has no advantage to offer except the strength of the metal and the adaptation to large canals that are not round in cross section. Failures with cast posts can be more catastrophic in nature compared to pre-fab ones.

If you insist on restoring the tooth, I suggest that the patient be fully informed of the compromised prognosis. Some recent research suggest that adhesive bonding of the post may reinforce the tooth from the inside and have a similar effect to a ferrule. There is not enough evidence to support this suggestion.

Short term studies reporting on fiber posts show promising results but are short term in nature lacking enough evidence. If I were to take a chance on this tooth, I may try a fiber post with a very conservative preparation, luted with an adhesive resin cement under optimal isolation conditions. Occlusal forces on the final restoration are to be minimal with no excursive contacts at all. Good luck!

In the scenario of compromised ferrule, I would like to suggest If possible do the crown lengthening procedure . Since it was not mentioned whether it is for anterior/ posterior, maxillary/mandible, it is hard to generalize the cast post/fibre post.

Based on my clinical experience and literature i would suggest to achieve 3- 4mm clinical crown height would be the primary criteria for the success of either fibre post/cast post and to achieve the feasible restoration

good luck!

I would recommend the following literature:

- In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations Original Research Article

The Journal of Prosthetic Dentistry, Volume 93, Issue 4, April 2005, Pages 331-336

Philip L.B. Tan, Steven A. Aquilino, David G. Gratton, Clark M. Stanford, Swee Chian Tan, William T. Johnson, Deborah Dawson

- Factors determining post selection: a literature review Review Article

The Journal of Prosthetic Dentistry, Volume 90, Issue 6, December 2003, Pages 556-562

Aquaviva S Fernandes, Sharat Shetty, Ivy Coutinho

- Fracture resistance of pulpless teeth restored with post-cores and crowns Original Research Article

Dental Materials, Volume 22, Issue 5, May 2006, Pages 477-485

Mikako Hayashi, Yutaka Takahashi, Satoshi Imazato, Shigeyuki Ebisu

5-year follow-up of a prospective clinical study on various types of core restorations

The Journal of Prosthetic Dentistry, Volume 94, Issue 4, October 2005, Page 403

N.H. Creugers, A.G. Mentink, W.A. Fokkinga, C.M. Kreulen

A publication written by us would be helpful...

K.E. Manning, D. C. Yu, H.C. Yu, E.W. Kwan, "Factors to Consider for Predictable Post and Core Build-ups of Endodontically Treated Teeth Part 1: Basic Theoretical Concepts, Journal of Canadian Dental Association, Vol 61, No. 8, pp 685-695, 1995., Part II; Clinical Application of Basic Concepts, pp 696-707.

Thank you.

if you insisted on restoring the tooth, you should do crown lenthening procedure.and then you choose the fiber post or cast post.if the crown lethening is not possible you cannot use fiber post with adhesive resine because optimal isolation is not possible in the gingiva.You should inform patient the prognose of the tooth but use gold alloy for post and crown luting with conventional cement

I agree with Dana Qeblawi. In addiction, you can get a ferrule effect using orthodontic movement or periodontal surgery procedures...

A good ferrule is must. I agree

The occlusal force (magnitude, direction, etc.) is deccisive for the decision (here of course antagonist teeth, parafunction habit, occlusal concept, etc.).

Position of the tooth in the arche is an important factor for the choice of post material.

if we use fiber post in the case of compromised ferrule effect ,how do you isolate this teeth from gingival fluid and how can you bond it with adhesive?the fiber post is weaker than metal and cannot reinforce this tooth.I think you should inform the patient about the short time treatment,and you can use cast post,with minimum occlusal force.

I'd go for crown lengthening with osseous re contouring. However it will depend on the case. Sometimes there are no options other than extraction. Careful treatment planning and case selection is recommended.

I agree with haroon. If u don't have ferrule think about crown lengthening or ortho extrusion. Ferrule increases the fracture resistance of the tooth. Custom metal post have high rigidity which in fact increases the stresses on the tooth/root. The good thing about fiber posts is their modulus of elasticity which is near to dentin. Finally, The choice between ready made or custom made is a matter of the shape of the canal and the remaining tooth structure.. 

** First important thing is the ferrule,

If there is 2mm ferrule, no difference in the fracture resistance between 2 types of posts,

" Impact of a Core Ferrule Design on Fracture Resistance of Teeth Restored with Cast Post and Core"

Loubna Shamseddine 1 , and Farid Chaaban 2

** Second, check occlusion for

1. Canine protect or group function for lateral forces, if its canine guidance , then no lateral forces

2. Parafunctional habits or deep bite

** Also what type of ferrule, is it missing on just one wall , or 3 walls or all 4 walls, if it's just one wall , mesial or distal , it has low risk..

Im totally against crown lengthening to gain ferrule. Its a harsh procedure. If i can maintain good moisture control i could use fiber post.