Effectiveness of horizontal posts to support MOD cavities compared with other restorative approaches in endodontically treated teeth: systematic review with meta-analysis of laboratory studies
Abstract Background Endodontically treated teeth often face challenges in maintaining structural integrity, particularly when restored with MOD cavities. This systematic review aimed to evaluate the mechanical behavior of endodontically treated premolar and molar teeth with MOD cavities, restored wi...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
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| Series: | BMC Oral Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12903-025-06022-1 |
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| Summary: | Abstract Background Endodontically treated teeth often face challenges in maintaining structural integrity, particularly when restored with MOD cavities. This systematic review aimed to evaluate the mechanical behavior of endodontically treated premolar and molar teeth with MOD cavities, restored with horizontal posts and composite materials, compared with alternative restorative approaches such as fiber-reinforced composites and indirect restorations. Methods A comprehensive search was conducted in December 2024 across various databases, including PubMed, Scopus, Web of Science, and Google Scholar. All studies that examined the application of horizontal posts in posterior endodontically treated teeth compared to other restorative methods were included, and manual searches of included studies and associated scientific websites were performed. The meta-analysis was accomplished through the Review Manager (RevMan 5.4) of the Cochrane Collaboration. Results The web search yielded 718 records, and 1 was added from the manual search. Following the PRISMA guidelines, 26 studies were ultimately included in this review. Horizontal posts in endodontically treated teeth significantly improved fracture resistance compared with untreated MOD cavities and many restorative methods, though they did not match sound teeth. Combining horizontal posts with materials like polyethylene fiber Ribbond or nanohybrid composites achieved fracture resistance comparable to sound teeth, while finite element analyses showed reduced stress concentrations. Horizontal posts also reduced non-restorable fractures compared to MOD cavities and bulk-fill composites, highlighting their mechanical advantage, especially when paired with advanced composites. Conclusions The insertion of horizontal posts significantly increased the fracture resistance of endodontically treated premolars and molars compared to composite restorations. Notably, fracture resistance levels were comparable to those observed in teeth restored with glass-fiber-reinforced composite and indirect ceramic restorations. However, there was no evident benefit from inserting root canal posts in enhancing fracture resistance. None of the restorative approaches achieved the fracture resistance levels of intact premolar and molar teeth. Clinical significant Proper support of ETTs with MOD cavities restored with direct composite restorations can preserve tooth integrity, particularly in case of large cavities. These supporting concepts are crucial in achieving complications-free restorations that maintain long-term clinical functionality. |
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| ISSN: | 1472-6831 |