Quite obviously, Dr. Tanchyk is a very conscientious and technically capable dentist. I agree with his comments and techniques. In my many years as a prosthodontist, I have had the opportunity to repeatedly accomplish the techniques he described.
In my opinion, both custom and prefabricated systems can and do work well. The challenge in today’s dentistry is that most practitioners and patients want techniques that are fast, easy, uncomplicated and effective. Many dentists will not become involved with any procedure that requires significant technical clinical effort. I assume that is the reason the use of custom-cast post and core has become minimal in the United States.
The following example is directly related to custom-cast post and cores. What is the longest-lasting Class III restoration? Some dentists know the answer. It is a well-placed, minimally invasive gold-foil restoration. I have some 45-year-old foils in my own mouth.
Will practitioners place them today? Only a few will take the time to do the meticulous procedure necessary for success. They will do a five-minute composite, which, by the way, is a fine restoration if placed properly. The gold foil technique requires more technical effort and is avoided by most practitioners. The same concept relates to custom-cast posts and cores.
I congratulate Dr. Tanchyk for his efforts to preserve the custom-cast post and core. I have similarly attempted to preserve the cast gold alloy inlay, onlay and crown. Unfortunately, it appears that the more technically difficult clinical procedures will continue to decrease in use to make way for simpler, easier, faster techniques.
