Journal of Prosthetic Dentistry

Effect of intraradicular fiber post on the fracture resistance of endodontically treated and restored anterior teeth: A systematic review and meta-analysis

Published:February 02, 2021DOI:


      Statement of problem

      A fiber post is indicated when there is a significant loss of tooth structure and additional support for the restoration is needed. However, whether the use of a glass fiber post affects the fracture susceptibility of the restored anterior teeth is unknown.


      The purpose of this systematic review and meta-analysis was to evaluate the fracture resistance of endodontically treated and restored anterior teeth and to answer the research question, “Does the use of a fiber post influence the fracture resistance of endodontically treated and restored anterior teeth compared with alternative restorative treatments?”

      Material and methods

      A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and Embase databases without date and/or language restrictions (updated in July, 2020). In vitro studies comparing the fracture strength of endodontically treated and restored anterior teeth with and without fiber posts were included. The risk of bias was evaluated by using the previous meta-analyses of in vitro studies. The results were presented as standardized mean difference with a 95% confidence interval. Statistical heterogeneity of treatment effects between studies was assessed using the Cochran Q test and the I2 inconsistency test, and values greater than 50% were considered indicative of substantial heterogeneity.


      After the removal of duplicates and title and abstract screening, 31 studies remained. Seventeen were considered low risk of bias, 10 were medium risk of bias, and 4 were high risk of bias. Meta-analysis comparing control and experimental groups favored the use of a fiber post in endodontically treated teeth with some types of restoration to improve fracture resistance (standardized mean difference= 0.5 [0.08; 0.92]); a glass fiber post was also favored (standardized mean difference=0.92 [0.43; 1.42]); for veneer preparations and teeth with cervical cavities, a fiber post increases the fracture strength (standardized mean difference= 0.74 [0.01; 1.47]; 1.18 [0.35; 2.02], respectively).


      The use of glass fiber posts increases the fracture resistance of endodontically treated and restored teeth.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Korkut B.
        • Yanikoglu F.
        • Gunday M.
        Direct composite laminate veneers: three case reports.
        J Dent Res Dent Clin Dent Prospects. 2013; 7: 105-111
        • Pini N.P.
        • Aguiar F.H.
        • Lima D.A.
        • Lovadino J.R.
        • Terada R.S.
        • Pascotto R.C.
        Advances in dental veneers: materials, applications, and techniques.
        Clin Cosmet Investig Dent. 2012; 4: 9-16
        • Coelho-de-Souza F.H.
        • Goncalves D.S.
        • Sales M.P.
        • Erhardt M.C.
        • Correa M.B.
        • Opdam N.J.
        Direct anterior composite veneers in vital and non-vital teeth: a retrospective clinical evaluation.
        J Dent. 2015; 43: 1330-1336
        • Mosharraf R.
        • Haerian A.
        Push-out bond strength of a fiber post system with two resin cements.
        Dent Res J. 2011; 8: 88-93
        • Rajambigai A.
        • Kumar A.
        • Sabarinathan Raja R.
        Comparison of stress distribution in a maxillary central incisor restored with two prefabricated post systems with and without ferrule using finite element Method.
        J Clin Diagn Res. 2016; 10: ZC52-ZC55
        • Skupien J.A.
        • Sarkis-Onofre R.
        • Cenci M.S.
        • Moraes R.R.
        • Pereira-Cenci T.
        A systematic review of factors associated with the retention of glass fiber posts.
        Braz Oral Res. 2015; 29: 1-8
        • Valdivia A.D.
        • Raposo L.H.
        • Simamoto-Junior P.C.
        • Novais V.R.
        • Soares C.J.
        The effect of fiber post presence and restorative technique on the biomechanical behavior of endodontically treated maxillary incisors: an in vitro study.
        J Prosthet Dent. 2012; 108: 147-157
        • Chieruzzi M.
        • Pagano S.
        • Cianetti S.
        • Lombardo G.
        • Kenny J.M.
        • Torre L.
        Effect of fibre posts, bone losses and fibre content on the biomechanical behaviour of endodontically treated teeth: 3D-finite element analysis.
        Mater Sci Eng C Mater Biol Appl. 2017; 01: 334-346
        • Barjau-Escribano A.
        • Sancho-Bru J.L.
        • Forner-Navarro L.
        • Rodriguez-Cervantes P.J.
        • Perez-Gonzalez A.
        • Sanchez-Marin F.T.
        Influence of prefabricated post material on restored teeth: fracture strength and stress distribution.
        Oper Dent. 2006; 31: 47-54
        • Lassila L.V.
        • Tanner J.
        • Le Bell A.M.
        • Narva K.
        • Vallittu P.K.
        Flexural properties of fiber reinforced root canal posts.
        Dent Mater. 2004; 20: 29-36
        • Sidoli G.E.
        • King P.A.
        • Setchell D.J.
        An in vitro evaluation of a carbon fiber-based post and core system.
        J Prosthet Dent. 1997; 78: 5-9
        • Clavijo V.G.
        • Reis J.M.
        • Kabbach W.
        • Silva A.L.
        • Oliveira Junior O.B.
        • Andrade M.F.
        Fracture strength of flared bovine roots restored with different intraradicular posts.
        J Appl Oral Sci. 2009; 17: 574-578
        • Barcellos R.R.
        • Correia D.P.
        • Farina A.P.
        • Mesquita M.F.
        • Ferraz C.C.
        • Cecchin D.
        Fracture resistance of endodontically treated teeth restored with intra-radicular post: the effects of post system and dentine thickness.
        J Biomech. 2013; 46: 2572-2577
        • Abduljawad M.
        • Samran A.
        • Kadour J.
        • Karzoun W.
        • Kern M.
        Effect of fiber posts on the fracture resistance of maxillary central incisors with Class III restorations: An in vitro study.
        J Prosthet Dent. 2017; 118: 55-60
        • Abduljawad M.
        • Samran A.
        • Kadour J.
        • Al-Afandi M.
        • Ghazal M.
        • Kern M.
        Effect of fiber posts on the fracture resistance of endodontically treated anterior teeth with cervical cavities: An in vitro study.
        J Prosthet Dent. 2016; 116: 80-84
        • AlQahtani A.
        • Albargash A.
        • Abduljabbar T.
        • Bahmmam F.
        • AbGhani S.M.
        Naseem M Fracture resistance of maxillary lateral incisors restored with different post systems.
        J Biomater Tissue Eng. 2017; 7: 1203-1207
        • Ambica K.
        • Mahendran K.
        • Talwar S.
        • Verma M.
        • Padmini G.
        • Periasamy R.
        Comparative evaluation of fracture resistance under static and fatigue loading of endodontically treated teeth restored with carbon fiber posts, glass fiber posts, and an experimental dentin post system: an in vitro study.
        J Endod. 2013; 9: 96-100
        • Bolhari B.
        • Mojazi Amiri E.
        • Kermanshah H.
        • Ghabraei S.
        • Jamei A.
        Fracture resistance of simulated immature teeth obturated with gutta-percha or Resilon and reinforced by composite or post.
        J Dent (Tehran). 2015; 12: 125-133
        • Carvalho C.A.
        • Valera M.C.
        • Oliveira L.D.
        • Camargo C.H.
        Structural resistance in immature teeth using root reinforcements in vitro.
        Dent Traumatol. 2005; 21: 155-159
        • Cauwels R.
        • Lassila L.V.J.
        • Martens L.C.
        • Vallittu P.K.
        • Verbeeck R.M.H.
        Fracture resistance of endodontically restored, weakened incisors.
        Dent Traumatol. 2014; 30: 348-355
        • D'Arcangelo C.
        • De Angelis F.
        • Vadini M.
        • D'Amario M.
        • Caputi S.
        Fracture resistance and deflection of pulpless anterior teeth restored with composite or porcelain veneers.
        J Endod. 2010; 36: 153-156
        • D'Arcangelo C.
        • De Angelis F.
        • Vadini M.
        • Zazzeroni S.
        • Ciampoli C.
        • D'Amario M.
        In vitro fracture resistance and deflection of pulpless teeth restored with fiber posts and prepared for veneers.
        J Endod. 2008; 34: 838-841
        • de Lima A.F.
        • Spazzin A.O.
        • Galafassi D.
        • Correr-Sobrinho L.
        • Carlini B.
        Influence of ferrule preparation with or without glass fiber post on fracture resistance of endodontically treated teeth.
        J Appl Oral Sci. 2010; 18: 360-363
        • de Magalhães Resende L.C.
        • de Araújo T.P.
        • Resende Â.B.
        • Cavalcanti Y.W.
        • de Almeida L.F.D.
        • Padilha W.W.N.
        • et al.
        Fracture resistance of endodontically treated teeth restored with different types of intracanal posts.
        Pesqui Bras Odontopediatria Clin Integr. 2017; 17: 1-12
        • Dikbas I.
        • Tanalp J.
        • Koksal T.
        • Yalnız A.
        • Güngör T.
        Investigation of the effect of different prefabricated intracanal posts on fracture resistance of simulated immature teeth.
        Dent Traumatol. 2014; 30: 49-54
        • Dean J.P.
        • Jeansonne B.G.
        • Sarkar N.
        In vitro evaluation of a carbon fiber post.
        Journal of Endodontics. 1998; 24: 807-810
        • de Oliveira J.A.
        • Pereira J.R.
        • do Valle A.L.
        • Zogheib L.V.
        Fracture resistance of endodontically treated teeth with different heights of crown ferrule restored with prefabricated carbon fiber post and composite resin core by intermittent loading.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: E52-E57
        • Dikbas I.
        • Tanalp J.
        • Ozel E.
        • Koksal T.
        • Ersoy M.
        Evaluation of the effect of different ferrule designs on the fracture resistance of endodontically treated maxillary central incisors incorporating fiber posts, composite cores and crown restorations.
        J Contemp Dent Pract. 2007; 8: 62-69
        • Evangelinaki E.
        • Tortopidis D.
        • Kontonasaki E.
        • Fragou T.
        • Gogos C.
        • Koidis P.
        Effect of a crown ferrule on the fracture strength of endodontically treated canines restored with fiber posts and metal-ceramic or all-ceramic crowns.
        Int J Prosthodont. 2013; 26: 384-387
        • Li Q.
        • Yan P.
        • Chen Z.
        Fracture resistance and failure patterns of open apex root teeth with different posts after endodontic treatment.
        Curr Med Sci. 2011; 31: 271
        • Makade C.S.
        • Meshram G.K.
        • Warhadpande M.
        • Patil P.G.
        A comparative evaluation of fracture resistance of endodontically treated teeth restored with different post core systems - an in-vitro study.
        J Adv Prosthodont. 2011; 3: 90-95
        • Mekayarajjananonth T.
        • Chitcharus N.
        • Winkler S.
        • Bogert M.C.
        The effect of fiber dowel heights in resin composite cores on restoration failures of endodontically treated teeth.
        J Oral Implantol. 2009; 35: 63-69
        • Nikhil V.
        • Jha P.
        • Aggarwal A.
        Comparative evaluation of fracture resistance of simulated immature teeth restored with glass fiber posts, intracanal composite resin, and experimental dentine posts.
        Scientific World Journal. 2015; 2015: 1-5
        • Ottl P.
        • Hahn L.
        • Lauer H.
        • Fay M.
        Fracture characteristics of carbon fibre, ceramic and non-palladium endodontic post systems at monotonously increasing loads.
        J Oral Rehabil. 2008; 29: 175-183
        • Ozcan M.
        • Valandro L.F.
        Fracture strength of endodontically-treated teeth restored with post and cores and composite cores only.
        Oper Dent. 2009; 34: 429-436
        • Sahafi A.
        • Peutzfeldt A.
        • Ravnholt G.
        • Asmussen E.
        • Gotfredsen K.
        Resistance to cyclic loading of teeth restored with posts.
        Clin Oral Investig. 2005; 9: 84-90
        • Salameh Z.
        • Sorrentino R.
        • Ounsi H.F.
        • Sadig W.
        • Atiyeh F.
        • Ferrari M.
        The effect of different full-coverage crown systems on fracture resistance and failure pattern of endodontically treated maxillary incisors restored with and without glass fiber posts.
        J Endod. 2008; 34: 842-846
        • Schmitter M.
        • Huy C.
        • Ohlmann B.
        • Gabbert O.
        • Gilde H.
        • Rammelsberg P.
        Fracture resistance of upper and lower incisors restored with glass fiber reinforced posts.
        J Endod. 2006; 32: 328-330
        • Toksavul S.
        • Toman M.
        • Uyulgan B.
        • Schmage P.
        • Nergiz I.
        Effect of luting agents and reconstruction techniques on the fracture resistance of pre-fabricated post systems.
        J Oral Rehabil. 2005; 32: 433-440
        • Topcuoglu H.S.
        • Kesim B.
        • Duzgun S.
        • Tuncay O.
        • Demirbuga S.
        • Topcuoglu G.
        The effect of various backfilling techniques on the fracture resistance of simulated immature teeth performed apical plug with Biodentine.
        Int J Paediatr Dent. 2015; 25: 248-254
        • Krithikadatta J.
        • Gopikrishna V.
        • Datta M.
        CRIS Guidelines. Checklist for Reporting In-vitro Studies): A concept note on the need for standardized guidelines for improving quality and transparency in reporting in-vitro studies in experimental dental research.
        J Conserv Dent. 2014; 17: 301-304
        • Avila W.M.
        • Hesse D.
        • Bonifacio C.C.
        Surface conditioning prior to the application of glass-ionomer cement: a systematic review and meta-analysis.
        J Adhes Dent. 2019; 21: 391-403
        • Hbibi A.
        • Sikkou K.
        • Khedid K.
        • Hamzaoui S.E.
        • Bouziane A.
        • Benazza D.
        Antimicrobial activity of honey in periodontal disease: a systematic review.
        J Antimicrob Chemother. 2020; 4: 807-823
        • Lagarde M.
        • Vennat E.
        • Attal J.P.
        • Dursun E.
        Strategies to optimize bonding of adhesive materials to molarincisor hypomineralization-affected enamel: A systematic review.
        Int J Paediatr Dent. 2020; 30: 405-420
        • Baldion P.A.
        • Betancourt D.E.
        • Gutierrez D.M.
        • Beltran E.O.
        • Lafaurie G.I.
        • Chambrone L.
        Influence of endodontic irrigants on bond strength between glass-fibre posts and dentin: A systematic review of in vitro studies.
        Int J Adhes Adhes. 2020; 102: 1-15
        • AlShwaimi E.
        • Bogari D.
        • Ajaj R.
        • Al-Shabrani S.
        • Almas K.
        • Majeed A.
        In vitro antimicrobial effectiveness of root canal sealers against Enterococcus faecalis: A systematic review.
        J Endod. 2016; 42: 1588-1597
        • Bellinaso M.D.
        • Soares F.Z.M.
        • Rocha R.O.
        Do bulk-fill resins decrease the restorative time in posterior teeth? A systematic review and meta-analysis of in vitro studies.
        J Investig Clin Dent. 2019; 10: 1-7
        • Lenzi T.L.
        • Gimenez T.
        • Tedesco T.K.
        • Mendes F.M.
        • Rocha R.O.
        • Raggio D.P.
        Adhesive systems for restoring primary teeth: a systematic review and meta-analysis of in vitro studies.
        Int J Paediatr Dent. 2015; 26: 364-375
        • Al Hashim N.S.A.-M.M.
        Al-attas HA Tooth colored post system: review of literature.
        Int J Contemp Dent. 2013; 4: 50-56
        • Shamseer L.
        • Moher D.
        • Clarke M.
        • Ghersi D.
        • Liberati A.
        • Petticrew M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.
        Br Med J (Clin Res Ed). 2015; 4: 1-9