I wish to thank Dr. Weisman for his interest in my article and for taking the time to express his comments about it. They have led me to reevaluate the manner in which I submitted the article.
It is clear from his remarks that the diagram I included may be misleading. It is meant to depict an empty post space with no dowel in the canal, parallel or otherwise. The fact that Dr. Weisman understands the figure to portray a post in place obviates the need for greater clarity on my part, and I regret this shortcoming.
It is also apparent from his observations that an endorsement of a particular post concept should be inferred from the illustration. This is not in fact the case. I modified a stock drawing to help demonstrate my technique, as one of the doctors who reviewed my manuscript suggested that a depiction would help clarify things. Those modifications were limited to the most coronal portion of the post space pictured and I left the remainder of the drawing unaltered. My inattention to detail on this point evidently has led to the misconception that the procedure I describe is particularly intended for use with parallel post designs and I regret this as well.
In my practice, I create tapered spaces as well as use tapered posts in almost all instances, as I concur with Dr. Weisman in his belief that this configuration is the most compatible with the contours of existing canals. The endodontist I refer to likewise leaves tapered post spaces for me after obturation. It has been my experience and the experience of colleagues I know that using tapered posts can raise problems of retention, which is why I came to develop this procedure.
I also agree with Dr. Weisman that cast gold posts and cores can serve as excellent foundations for full-coverage restorations. I routinely used them earlier in my career, but I found that they did have some disadvantages.
I believe that placing cast gold posts and cores is fairly technique-sensitive and I have seen root fractures with this type of restoration. I believe too that the method outlined in my article effectively addresses the interface issue that Dr. Weisman raises. Obtaining patterns for casting, from molar teeth especially, can also be somewhat technique-sensitive and the potential for defective castings necessitating refabrication is very real. While the material costs may not be that disparate, the laboratory fee involved has normally made the expense of a cast post and core significantly higher than that of a prefabricated metal post and resin core in my experience.
Convenience is also an issue. Besides taking two appointments at least (if no remake is involved), using a cast post and core may require the fabrication of a temporary post and core/crown combination, requiring more chair time and further increasing its cost.
In my clinical experience, I have not seen a higher rate of failure (for any reason) with properly placed prefabricated metal posts and resin cores than with cast gold posts and cores. I have, however, found the former to be more predictable, convenient and cost-effective. It is for these reasons that I advocate their use while acknowledging that cast gold posts and cores, like gold foil restorations, for example, can still play an important role in restorative dentistry for practitioners well-versed in their use.
I am pleased to have this opportunity to respond to Dr. Weisman’s thoughtful comments.
