Fracture resistance of endodontically-treated maxillary premolars restored with different type of posts and direct composite reconstructions: A systematic review and meta-analysis of in vitro studies. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Iaculli, Flavia; Rengo, Carlo; Lodato, Vincenzo; Patini, Romeo; Spagnuolo, Gianrico; Rengo, Sandro
• Is Part Of: Dental materials. Volume 37:Issue 9(2021)
• Page Start: e455
• Page End: e484
• Publication Date: 2021-09
• Subjects: Direct composite restoration -- Endodontically-treated teeth -- Fiber post -- Fracture resistance -- Maxillary premolars -- Metal post; Dentistry -- Periodicals; Dental materials -- Periodicals; 617.695
• DOI: 10.1016/j.dental.2021.06.007
• Languages: English
• ISSNs: 0109-5641

Abstract

Graphical abstract: Highlights: Posts increased fracture resistance of endodontically-treated maxillary premolars. Direct composite reconstructions did not interfere with fracture resistance. Fiber posts enanched restorable fractures and decreased root fractures. Abstract: Objective: To conduct a systematic review and meta-analysis to assess if the presence of an endodontic post may increase the fracture resistance of endodontically-treated maxillary premolars directly restored with composite. Methods: A comprehensive systematic literature search according to the PRISMA statement was conducted to assess in vitro studies including endodontically-treated maxillary premolars, restored with different type of posts supporting direct composite reconstructions. Two groups of meta-analyses were performed using fixed effects model and additional Trial Sequential Analysis (TSA) was carried out. Moreover, risk of bias was conducted and quality of evidence for any performed meta-analysis was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Twenty-four articles met the inclusion criteria and 13 studies also underwent quantitative evaluation. Fracture resistance of endodontically-treated premolars restored with fiber posts was significantly less than sound teeth ( p value: < 0.00001), however endodontically-treated premolars with a fiber post provided an increase in fracture resistance when compared to equivalent teeth restored without post ( p value: 0.003). TSA revealed high power of both meta-analyses. Moderate risk of bias was reported in 23/24 studies; only 1 study showed high risk of bias. GRADE system showed moderate strength of evidence due to the presence of a study with high risk of bias and to wide confidence intervals. Significance: Within the limitation of the present systematic review and meta-analysis, it can be concluded that endodontically-treated maxillary premolars restored with a fiber post and direct composite restoration demonstrated increased fracture resistance when compared to equivalent teeth without post.