Short fiber-reinforced composite resins as post-and-core materials for endodontically treated teeth: A systematic review and meta-analysis of in vitro studies

Ektoras Fousekis; Andreas Lolis; Emmanouil Marinakis; Elissaios Oikonomou; Petros Foros; Despina Koletsi; George Eliades

doi:10.1016/j.prosdent.2023.09.026

Short fiber-reinforced composite resins as post-and-core materials for endodontically treated teeth: A systematic review and meta-analysis of in vitro studies

J Prosthet Dent. 2023 Oct 31:S0022-3913(23)00643-1. doi: 10.1016/j.prosdent.2023.09.026. Online ahead of print.

Authors

Ektoras Fousekis¹, Andreas Lolis¹, Emmanouil Marinakis¹, Elissaios Oikonomou², Petros Foros¹, Despina Koletsi³, George Eliades⁴

Affiliations

¹ Researcher, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
² Researcher, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: elisoik@gmail.com.
³ Senior Teaching and Research Staff, Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland; and Research Affiliate, Meta, Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, Calif.
⁴ Professor and Director, Department of Dental Materials, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 37919126
DOI: 10.1016/j.prosdent.2023.09.026

Abstract

Statement of problem: As the use of traditional posts has been associated with complications and failure outcomes, the introduction of novel materials and minimally invasive dentistry has shifted toward the use of composite resin post-and-core restorations for endodontically treated teeth. As a further process, to improve stress absorption environment in restored teeth, the invention of short fiber-reinforced composite resins (SFRCs) as post-and-core restorations has recently emerged. However, evidence regarding its performance is still scarce, and a synthesis of existing data is lacking.

Purpose: The purpose of this systematic review and meta-analysis was to assess the performance of SFRC post-and-core restorations, regarding fracture resistance and failure mode and considering both cyclic and static loading.

Material and methods: An electronic search in 5 databases was conducted up to August 2022, and the protocol of the study was registered a priori. The search terms included "fiber reinforced composite," "core build-up," and "post." Studies were considered if they compared SFRC restorations with other types of conventional posts and teeth restored using bulk fill composite resin. The internal validity of the studies was assessed by using a custom-made risk of bias tool.

Results: A total of 1271 records were identified, of which 13 were considered for full-text assessment. Eight were ultimately included, all being in vitro studies, and 7 of them were deemed eligible for quantitative syntheses. The results varied considerably across studies with divergent fracture resistance values and percentages of catastrophic failure being reported. Standard depth (6 mm) SFRCs presented fewer repetitions until fracture on average, compared with the individually made FRCs (3 studies: mean difference (MD): -4062; 95% CI: -6148, -1975; P<.001) under cyclic loading. Under static loading, SFRCs (standard depth) presented a nearly 300 N lower fracture force compared with that of intact teeth, (3 studies: MD: -297; 95%CI: -378, -216; P<.001).

Conclusions: Evidence on the laboratory fracture and failure performance of SFRCs is limited, and future studies should incorporate more standardized experimental conditions, as well as SFRCs with limited sacrifice of tooth substrate within the root canal of endodontically treated teeth.

Publication types

Review