Is the use of an intraradicular post essential for reducing failures in restoring endodontically treated teeth? A systematic review and meta-analysis

Abstract

Objectives: This systematic review aimed to evaluate whether the use of posts reduces failure rates in endodontically treated teeth compared to restorations without posts.

Data sources: The systematic review followed the Cochrane Handbook of Systematic Reviews of Interventions and adhered to the PRISMA checklist. The study was registered in the PROSPERO (CRD42021258906).

Study selection: Electronic database searches were conducted in MEDLINE/PubMed, Embase, Scopus, and Web of Science up to October 2024, with supplementary searches in the grey literature (ProQuest and ClinicalTrials.gov). The risk of bias was assessed using the RoB 2.0 tool, and certainty of the evidence was performed using GRADE. A meta-analysis was performed using the RevMan 5.4 program, with the significance level set at P < .05.

Results: The search identified 2352 articles, of which 23 articles were selected for full-text analysis, and 13 randomized clinical trials were included in the synthesis. Overall, restorations with posts showed significantly lower failure rates compared to those without posts (P = .001; Risk Ratio [RR]: 0.61). Subgroup analysis demonstrated favorable outcomes for post-use in indirect restorations (P < .001; RR: 0.44). whereas no significant differences were observed for direct restorations (P = .74; RR: 1.10). Further analysis revealed significant benefits only for prefabricated fiber posts (P < .001; RR: 0.54) and customizable fiberglass posts (P = .001; RR: 0.66). In contrast, cast post and core (P = .66; RR: 0.84) and prefabricated metallic posts (P = .67; RR: 1.19), showed no significant difference compared to restorations without posts. Five of the included studies had a low risk of bias, while seven were rated as having some concerns. The overall certainty of the evidence was classified as low due to the risk of bias, indirectness, and imprecision.

Conclusions: Prefabricated or customized fiber posts effectively reduce failure risk in endodontically treated teeth in cases of indirect restorations. For direct restoration, the use of posts appears optional and should be determined based on case-specific factors. However, further well-designed randomized clinical trials are needed to confirm these findings due to the low certainty of evidence.

Clinical significance: Prefabricated or customized fiber posts are recommended for supporting coronal reconstruction in indirect restorations of endodontically treated teeth. In contrast, direct restorations allow for dental reconstruction without the use of intraradicular posts.

Keywords: Failures; Nonvital; Post and core technique; Postless; Without post.