Post and Core: Rebuilding a Tooth With Little Structure Left
If a root-filled tooth has little structure left, a post and core can give a crown something to hold. The post retains the core; guidance says it is not there to strengthen the tooth or root. Evidence suggests the sound tooth remaining, including a ferrule, matters more. The page also covers post types, root fracture and alternatives.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, the practice's principal dentist, reviewed this page. He is a General Dental Practitioner (GDC number 301711) with BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
What is a post and core?
A post and core is a foundation that holds a crown on a root-filled tooth with little structure left.
The dental post sits in the root canal space. The core, or core build-up, replaces the missing part of the tooth, and the crown covers the core and the remaining coronal dentine, the tooth structure left above the root. The British Endodontic Society (BES) guide calls the finished restoration a post crown.
When is a post needed?
In general, a post is considered when the tooth that remains cannot hold a core.
A 2022 International Endodontic Journal (IEJ) review names remaining tooth structure and tooth type as key factors. It recommends a post where no walls or one wall remain, and says back teeth whose pulp chamber has adequate depth and shape to hold a core can be reliably restored without one. It calls the evidence on restoring root-filled teeth complex and unclear.
The 2025 British Dental Journal (BDJ) review says posts are very seldom required in molars and used more often in front teeth and premolars.
Our pages on a crown after root canal and a badly broken down tooth cover whether the tooth needs a crown, or can be saved.
Does a post strengthen a tooth?
Guidance says no: a post retains the core and is not there to strengthen the tooth or root.
Early ideas held that a post may reinforce a root-filled tooth. The BES guide says a post's purpose is to retain the core, not to strengthen the root or make up for a missing ferrule. The BDJ review adds that removing tooth to fit a post weakens what remains and even bonded posts do not reinforce the root.
The IEJ review calls any contribution of bonded posts to the root's stability questionable, and mainly considered for weakened, injured upper front teeth with thin dentine walls.
A 2018 review of eight clinical studies, five at high risk of bias, found seven showed no effect from a post. A six-year trial of 360 crowned premolars found better tooth survival with a fibre post than without one.
How do fibre and cast metal posts compare?
Most reviews find fibre and metal posts perform similarly, on limited evidence, though one review of four trials favoured fibre for survival.
| Study | Posts and teeth | Result |
|---|---|---|
| Martins 2021, review of 10 trials | 453 fibre, 391 metal | Failures similar, including root fracture, debonding, and fibre against cast. Low certainty. |
| Wang 2019, review of 4 randomised trials | Two walls or fewer, 3 to 7 years | Higher survival with fibre (high-quality evidence). No difference in success (moderate quality), debonding or root fracture. |
| Figueiredo 2015, review of 7 trials, 7 cohort studies | Over 5 years | Pooled survival 83.9% fibre, 90% metal. Root fractures similar overall. High risk of bias. |
| Sarkis-Onofre 2020, randomised trial | No ferrule: 111 fibre, 72 cast, median 62 months | Annual failure 1.7% fibre, 1.2% cast; survival not significantly different. Root fractures were 10 of 23 failures across both arms. |
| Naumann 2017, randomised pilot trial | Two walls or fewer, 2 mm ferrule: 45 fibre, 46 titanium; 56 of 91 reported at 11 years | Cumulative survival 58.7% fibre, 74.2% titanium; 12 and 7 failures. Rigidity did not influence survival, which fell rapidly after 8 years in both. |
| Schmitter 2011, randomised trial | 100 patients, 81 at recall: fibre or long metal screw, 5 years | Survival 71.8% fibre, 50% metal screw, significantly different. |
Only the Martins and Sarkis-Onofre rows name cast posts, and reviews may share trials.
A 2017 review of 11 trials, most at unclear risk of bias, found similar short- to medium-term performance, though of six fibre-metal comparisons, one favoured fibre and one metal. Fibre posts failed mainly through lost retention, and metal posts through root fracture, post fracture or lost retention. In the 11-year pilot trial, root fractures numbered four with fibre and one with titanium.
Sources differ on root fracture: the BDJ review says fibre posts are less likely than metal to cause it, but the table's three reviews found no significant difference, and the IEJ review, citing two of them, finds no clinical evidence so far that post rigidity affects it. On tooth survival, the BES guide says post material has no effect.
A cast metal post and core can limit a front all-ceramic crown's appearance and bonding, the BDJ review says; our page on crown materials compares the options.
Why does guidance call for a ferrule?
Guidance says a post and core needs a ferrule, a ring of dentine above the gum, to retain the crown predictably on sound tooth.
The BES guide says clinicians should make every effort to provide an optimum ferrule, though varied clinical research makes specific guidance difficult. It cites a 2012 review as suggesting a minimum 1.5 to 2.5 mm high, 2 mm thick. That review concluded that 1.5 to 2 mm has a positive effect on fracture resistance, and a partial ferrule is considered better than none.
A 2016 meta-analysis found teeth without a ferrule resisted fracture less in laboratory tests, while clinical studies linked a ferrule to longer survival, though only for premolars. The IEJ review says firm conclusions on survival are not possible. A 2018 review, five of its eight studies at high risk of bias, called the ferrule and kept walls the predominant factors, with two of three relevant studies supporting the ferrule.
The six-year premolar trial found lower failure risk with one to three walls than with no ferrule, but similar risk with or without one where no walls remained. A 2020 trial of teeth without one reported good performance, with 23 failures among 183 posts.
Questions about this treatment? Book online or call the practice.
What is the risk of root fracture with a post?
Root fracture is a recognised risk of a post and core, and one review classes it as a catastrophic failure.
A 2003 review averaging 50 years of reports found complications in 10% of posts and cores, with post loosening in 5%, root fracture in 3% and decay in 2%. The BDJ review says load can pass mainly to the post, causing post fracture, or tooth fracture where there is no significant ferrule.
Other risks include:
- Perforation: threaded or parallel posts are more likely to perforate the side of the root, the BDJ review says. In the 2011 trial, 17 metal screw group teeth were extracted for fractures or perforations.
- Lost retention: in the 2011 trial some fibre restorations loosened, six patients did not notice, and teeth were extracted, so show a loose crown to a dentist.
- Reinfection: making post space can disturb the root filling's seal, so the BES guide says at least 4 to 5 mm of root filling should stay.
What are the alternatives to a post and core?
In general, alternatives include restoring without a post, an endocrown, creating a ferrule first or removing the tooth.
- No post: in back teeth whose pulp chamber can hold a core, a crown or onlay may go over it.
- Endocrown: a laboratory-made crown extending into the pulp chamber, which the IEJ review calls a viable option for premolars and molars, given good bonding.
- Creating a ferrule first: where no natural crown remains, the 2012 review favours considering orthodontic extrusion, moving the tooth further out, over surgical crown lengthening. If neither can be done, it says a poor outcome is very likely on available evidence.
- Removing the tooth: extraction may be necessary where gross tooth tissue loss makes survival poor, the BES guide says. A bridge, denture or dental implant can then replace it.
When should you speak to a dentist about a post?
Speak to a dentist if a crown on a post feels loose, or if the tooth hurts, swells or breaks.
- See a dentist if you have toothache that lasts more than 2 days, that does not go away with painkillers, with a high temperature, pain when you bite, red gums or a bad taste in your mouth, or with a swollen cheek or jaw. Do not go to your GP, as they will not be able to give you dental treatment.
- If you have no dentist or cannot get an emergency appointment, call 111 or visit 111 online.
- Go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak. Do not drive: ask someone to drive you or call 999 for an ambulance. Bring any medicines you take.
Does Deepcar Dental Care provide post crowns?
Yes, treatments at Deepcar Dental Care include post crowns, with fibre posts or cast metal posts.
Are post crowns priced on the fee list?
The practice's fee list does not name post crowns, and it does not say whether any of its lines covers them.
Where can you read more?
A post and core follows endodontic treatment, meant to save a damaged tooth rather than remove it. It belongs with repairing and rebuilding damaged teeth, which keeps natural teeth where implants would replace them.
Our patient reviews give people's views of the practice.
Frequently asked questions
How long does a post and core last?
No single figure applies. A 2022 review says results vary with the tooth left, the ferrule and the final restoration, with about 90% survival at 5 to 7 years for teeth with fibre posts. One 11-year pilot trial recorded 58.7% with fibre and 74.2% with titanium.
Can a post be taken out again?
Sometimes. British Endodontic Society guidance says removal may be achieved with special equipment, though a large immovable post can make re-treatment high risk. A 2025 review says metal posts offer some retrievability if they fracture, while ceramic or zirconium posts are virtually impossible to remove if fractured.
What should you do if a tooth with a post fractures?
See a dentist, not a GP, NHS guidance says about a chipped, cracked or broken tooth. Keep a broken-off piece in milk or saliva for the dentist. Call your dentist first; their answerphone may help if they are closed. With no dentist or emergency appointment, call 111.
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