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.

中文翻译：

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不同类型桩和直接复合重建修复牙髓治疗上颌前磨牙的抗断裂性：体外研究的系统评价和荟萃分析

客观的

进行系统评价和荟萃分析，以评估牙髓桩的存在是否可以增加用复合材料直接修复的牙髓治疗上颌前磨牙的抗断裂性。

方法

根据 PRISMA 声明进行了全面系统的文献检索，以评估体外研究，包括经牙髓治疗的上颌前磨牙，用支持直接复合重建的不同类型的桩修复。使用固定效应模型进行了两组荟萃分析，并进行了额外的试验序列分析（TSA）。此外，还进行了偏倚风险，并使用建议评估、制定和评估分级 (GRADE) 评估了任何进行的荟萃分析的证据质量。

结果

24 篇文章符合纳入标准，13 项研究也进行了定量评估。用纤维桩修复的牙髓治疗前磨牙的抗断裂性显着低于健康牙齿（p值：< 0.00001），但是与没有桩修复的等效牙齿相比，用纤维桩修复的牙髓治疗前磨牙提供了更高的抗断裂性（p值：0.003）。TSA 揭示了两种荟萃分析的强大功效。23/24 研究报告了中等偏倚风险；只有 1 项研究显示存在高偏倚风险。由于存在高偏倚风险和宽置信区间的研究，GRADE 系统显示出中等强度的证据。

意义

在本系统评价和荟萃分析的限制内，可以得出结论，与没有桩的等效牙齿相比，使用纤维桩和直接复合修复进行牙髓治疗的上颌前磨牙表现出更高的抗断裂性。