title: Do metal post-retained restorations result in more root fractures than fiber post-retained restorations? A systematic review and meta-analysis.
abstract: BACKGROUND
  Teeth requiring endodontic treatment commonly have compromised a coronal tooth structure that often requires the use of an intraradicular post to retain the coronal restoration. Although usually successful, catastrophic failures requiring extraction have been reported in the literature. The aim of this systematic review was to analyze clinical trials and cohort studies that evaluated the incidence rate of root fractures in post-retained restorations. The hypothesis was that the incidence rate related to the use of metal posts was higher than that of fiber posts.
  
  
  METHODS
  A MEDLINE search for clinical studies reporting the incidence of root fractures of restorations retained with fiber posts or metal posts of endodontically treated teeth with a more than 5-year follow-up was conducted from inception to January 2014. Seven randomized clinical trials and 7 cohort studies were included.
  
  
  RESULTS
  The pooled survival rate was 90% (95% confidence interval, 85.5-93.3) for metal-based posts and 83.9% (95% confidence interval, 67.6-92.8) for fiber-reinforced posts. The overall incidence rate of root fractures (catastrophic failures) was similar between metal and fiber posts. Prefabricated metal posts and carbon fiber posts had a 2-fold increase in the incidence rate of root fractures compared with cast metal posts and glass fiber posts, respectively.
  
  
  CONCLUSIONS
  The results of this study did not show significant differences for root fracture incidence between metal- and fiber posts. However, the studies included in this review presented a high risk of bias, and further well-designed clinical studies are required to confirm these findings.
authors.affiliation: Department of Dentistry, Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Fabrício Eneas Diniz
authors.initials: FE
authors.lastname: Figueiredo
authors.affiliation: Department of Health Education, Universidade Federal de Sergipe, Sergipe, Brazil.
authors.forename: Paulo Ricardo Saquete
authors.initials: PR
authors.lastname: Martins-Filho
authors.affiliation: Department of Dentistry, Universidade Federal de Sergipe, Sergipe, Brazil. Electronic address: fariaesilva.andre@gmail.com.
authors.forename: André Luis
authors.initials: AL
authors.lastname: Faria-E-Silva
mesh_terms: D003793:Dental Restoration, Permanent; D005500:Follow-Up Studies; D005898:Glass / Q000737:chemistry*; D006801:Humans; D015994:Incidence; D008670:Metals / Q000494:pharmacology*; D011176:Post and Core Technique; D017594:Publication Bias; D014082:Tooth Fractures / Q000453:epidemiology / Q000628:therapy*; D014092:Tooth Root / Q000187:drug effects / Q000473:pathology*
chemical_list: D008670:Metals; C009753:fiberglass
keywords: Dental restoration failure; endodontically treated teeth; meta-analysis; post and core technique