Hindawi

International Journal of Dentistry

Volume 2022, Article ID 4748291, 10 pages
https://doi.org/10.1155/2022/4748291

Review Article
An Umbrella Review of Systematic Reviews and Meta-Analyses
Evaluating the Success Rate of Prosthetic Restorations on
Endodontically Treated Teeth

Amirhossein Fathi ,1 Behnaz Ebadian,2 Sara Nasrollahi Dezaki,3 Nahal Mardasi,4

Ramin Mosharraf,1 Sabire Isler,5 and Shiva Sadat Tabatabaei3
1
Department of Prosthodontics, Dental Materials Research Center, Dental Research Institute, School of Dentistry,
Isfahan University of Medical Sciences, Isfahan, Iran
2
Dental Implants Research Center, Department of Prosthodontics, School of Dentistry, Isfahan University of Medical Sciences,
Isfahan, Iran
3
Dental Students’ Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
4
Department of Prosthodontics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5
Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey

Correspondence should be addressed to Amirhossein Fathi; amir_alty@yahoo.com

Received 5 December 2021; Revised 20 January 2022; Accepted 3 February 2022; Published 22 February 2022

Academic Editor: Stefano Pagano

Copyright © 2022 Amirhossein Fathi et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Statement of the Problem. Various direct and prosthetic restorations are clinically used to restore endodontically treated teeth.
However, determining the most successful and reliable treatment to restore endodontically treated teeth is affected by numerous
elements and still unclear for most clinicians. Therefore, this umbrella review study assessed the systematic/meta-analytic reviews
(S/M-R) regarding the success rate of prosthetic restorations in endodontically treated teeth. Materials and Methods. The
electronic search was conducted in the MEDLINE/PubMed, Cochrane, and Google Scholar databases until November 2020,
regardless of language limitations. The inclusion criterion was as follows: S/M-R regarding prosthetic restorations in end-
odontically treated teeth. Three qualified researchers evaluated the inclusion criteria and bias risk. The fourth investigator was
referred to when facing any doubtfulness. Results. From 43 achieved S/M-R, 14 studies were selected for this inquiry. Primary
extracted information included success rate, survival rate, and postendodontic failure rate. Five S/M-R had a moderate risk of bias,
and nine S/M-R had a low risk of bias and were considered strong clinical evidence in this examination. According to the low-risk
reports, the success rate of fiber posts was higher than that of metal posts; the rate of root fracture in metallic and fiber posts was
alike; the failure rate for fiber posts was comparable to fixed partial dentures or single crowns; the construction of endocrowns was
likely to perform better than intracanal posts, composite resin, or inlay/onlay restorations. Conclusion. It appears that with
practice and experience, deciding which type of restoration to choose changes. In dental restorations associated with root canal
therapy, the single crowns are likely to be a proper option. Nevertheless, due to the heterogeneity of the studies, more clinical
assessments are required to achieve more specific findings in this field.

1. Introduction [10, 11]. Determining the proper restoration for an end-

odontically treated tooth is associated with the number of
Endodontic therapy is a routine and standard dental vital teeth, anatomical situation, occlusal pressure, and re-
treatment [1–7]. Through endodontic therapy, tooth ma- storative and aesthetic necessities of the tooth [12]. In
terial is unavoidably sacrificed, and the tooth is weakened general, benefits can be achieved through both traditional
[8, 9]. It is thereby apparent that ET teeth require restoration direct restorations and prosthetic restorations such as
2 International Journal of Dentistry

crowns, fixed partial dentures, removable partial dentures, Table 1: PICO strategy.
and mixed removable-fixed prostheses, with or without PICO inquiry Description
postplacement.
Population Teeth receiving root canal treatments
The application of posts has been widely discussed in Intervention Restoring endodontically treated teeth
dentistry for a long time, and they are commonly suggested Comparison No comparison was determined
when the amount of remaining hard tissue is crucial [13, 14]. Outcome Survival rate and failure rate of restored ET teeth
Popular postsystems consist of both cast and prefabricated
posts with a broad order of substances. The use of different
posts requires applying particular principles [15]. Recently, [40, 41]. The purpose of this overview was to find S/M-R
fiber-reinforced posts have been introduced in addition to determining ET teeth restoration success and evaluate the
traditional metal posts to preserve teeth with a small amount quality level of studies on the success of ET teeth treatment
of residual structure. Since mechanical properties of the methods.
whole system, including post, cement, and dentine should be
homogenous, engaging in fiber posts cemented and 2. Materials and Methods
reconstructed by composite resin material is likely to ensure
a good performance [16]. 2.1. Search Strategy. Electronic search was conducted in
When it is impossible to use implants, removable or fixed PubMed/MEDLINE, Cochrane, and Google scholar data-
dentures, restoring ET teeth is more critical. The results of a bases until November 2020 without language limitation. The
systematic examination [17] showed that the retention, research included S/M-R and their references that examined
satisfaction, and cost-effectiveness of restored teeth with a the success of prosthetic procedures in ET teeth.
single crown or implant are higher than fixed or removable The PICO inquiry (population, intervention, compari-
dentures. However, other systematic studies have found no son, and the outcome) was followed. The population in-
significant difference between the survival rate of restored cluded teeth that have received root canal treatments. The
ET teeth with single crowns and implants [18]. intervention was providing restorations for ET teeth. There
Based on several current systematic reviews [19], end- was no control; hence, no comparison was performed. The
odontically treated (ET) teeth present a predicted survival outcome contained the survival rate and failure rate of re-
rate of 87% within eight to ten years. Researchers evaluated stored ET teeth (Table 1).
cases of monitoring teeth after both first endodontic therapy This review study was conducted using the guidance on
and retreatment, excluding periapical surgery treatments. preferred reporting elements for systematic reviews and
Different epidemic-related studies [20], where a substantial meta-analyses [42]. The AMSAR2 [43] method was also used
cohort was examined (over one million cases), obtained a for calculating the risk of S/M-R bias. Selected keywords
survival rate of 97% in ET teeth after eight years. included “prosthetic restorations” and “endodontically
One of the most influential and determining factors for treated teeth.”
the success of endodontic therapy is whether a periapical Inclusion and exclusion criteria in S/M-R screening.
injury exists former to practice [21–25]. Other circum- Inclusion criteria were as follows:
scribing parameters contain the amount of the root filling in
(1) S/M-R studies
association with the root crown [22–24, 26], pulp status
before therapy [23, 24], postendodontic coronal restoration (2) Studies in English language only
[20, 25, 27, 28], and proximal contacts [19]. It is assumed (3) Evaluating the success/failure rate of prosthetic
that molars exhibit significantly lower survival rates than restorations in endodontically treated teeth.
other teeth; this theory has been confirmed by former cohort
investigations [29, 30]. Others have been incapable of no- Exclusion criteria included duplicate reviews, comments,
tably relating particular teeth to the durability of treatment and editorials.
[31]. More elements have also been examined in previous Full texts of studies that met our inclusion criteria were
reports. However, confirmation of their influence on the received, and these studies were considered eligible for our study.
survival rate of ET teeth is weak or uncertain. These factors
include age [24, 25, 31], the kind of post [32–35], root filling 2.2. Data Collection Process. The data were collected by three
mass [24, 27], and the number of sessions until the end of independent researchers who had already received adequate
endodontic therapy [36, 37]. training in this field (kappa � 1.0). Required information
Despite the abundance of S/M-R in this area, a lack of such as prosthesis type, success, and survival rate was
consensus is seen among specialists [38, 39] and information extracted from each systematic study. If there were any
gaps cause failures in clinical practice. Therefore, valid inconsistencies or ambiguities, the matter was resolved
scientific documentation is required to make a proper de- through discussion. If the issue was not resolved, the fourth
cision. Considering the lack of compliance among studies on investigator was asked to provide assistance.
a particular technique or methodology and since scientific
studies require impartiality, Cochrane proposed a new kind
of study called the S/M review, in which findings from 2.3. Bias Risk Assessment. Based on the risk of bias assess-
multiple S/M-R are combined into one text to increase ment [43], 16 questions were used to evaluate the quality and
confidence in decision-making by comparing scientific data bias of the S/M-R (Table 2). In the end, each article received a
 International Journal of Dentistry

Table 2: The assessment of multiple systematic reviews (AMSTAR2).

Results Criteria for
Exclude Include Risk of RoB on RoB in
Question & Study Comprehensive Study Data Funding Statistical Explanation for Publication Conflict according to AMSTAR
Protocol study study bias meta- individual
inclusion design search selection exclusion sources methods heterogeneity bias of interest number of analysis Review
References justification details (RoB) analysis studies
yeses according to quality
positives
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 -
answers
[44] Y PY Y PY Y N N PY N N Y N Y N N N 5 Moderate risk Low
[45] Y PY Y PY Y N N PY PY N N Y Y N N N 5 Moderate risk Low
[46] Y Y Y Y Y Y Y N PY N Y Y Y Y Y N 12.5 Low risk High
[47] Y PY Y Y Y Y N PY PY N NMC NMC N N NMC Y 6.5 Moderate risk Moderate
[48] Y Y Y Y Y Y N PY Y N NMC NMC Y Y NMC Y 10.5 Low risk High
[49] Y PY Y PY Y Y Y PY N N NMC NMC N N NMC Y 7.5 Low risk Moderate
[50] Y PY Y PY Y N Y PY Y N NMC NMC N N NMC Y 7.5 Low risk Moderate
[51] Y Y Y PY Y N N PY Y N Y Y Y N Y N 10 Low risk High
[52] Y Y Y PY Y N Y PY Y Y Y Y Y Y Y Y 14 Low risk High
[53] Y Y Y Y Y N N PY Y N Y Y Y Y Y Y 12.5 Low risk High
[54] Y Y Y PY Y N Y Y N N Y N N Y N Y 9.5 Low risk Moderate
[55] Y Y Y Y Y N Y Y Y N Y Y N Y Y N 12 Low risk High
[56] Y PY Y PY Y Y N Y N N N N N N N N 6 Moderate risk Moderate
[57] Y PY Y PY N N N PY N N N N N N N N 3.5 Moderate risk low

Y: yes; N: no; PY: partial yes; NMC: no meta-analysis conducted. Overall methodological quality: low: 0–5; moderate: 5–10; high: 10–16. Criteria for AMSTAR analysis according to positive answers: low risk (8–11),
moderate risk (4–7), and high risk (≤3).
3
4 International Journal of Dentistry

Records identified through Records identified through

PUBMED/MEDLINE Cochrane and Google

Identification
database searching scholar database searching

Records excluded
(n= 24)
Considered irrelevant
by consensus
Screening

1st screening: Title &

Abstract
Eligibility

(n= 17)

Full-text articles assessed

Full-text excluded for the
following reasons
(n= 3)
Duplication
(n= 14)
Included

Included in qualitative Comment

analysis

Figure 1: Flowcharts for the studies were identified, displayed, and included in the study.

score that indicated the risk of bias in that study. If eight to correct responses, the level of bias was reported as high,
eleven positive responses were received, the risk of bias was medium, or low (Table 2). In this study, the risk of bias was
low; if four to seven questions were answered positive, the moderate [including five S/M-R: [44, 45, 47, 56, 57]] and low
risk of bias was moderate; and if fewer than three questions [including nine S/M-R: [46, 48–55]]. In addition, 41.5% of all
received a positive response, the risk of bias was assessed as surveys represented low-risk S/M-R (Table 1). Reliable
high [40]. The assessment was conducted by two qualified clinical evidence was expected from S/M-R studies with a
investigators (kappa � 0.9). If there were any inconsistencies low risk of bias.
or ambiguities, the matter was resolved through discussion.
If the ambiguities were not cleared up, the third investigator
was asked to assist. 3.3. Characteristics of Systematic Reviews. General infor-
mation of each S/M-R is presented in Table 3. They include
3. Results authors and year of publication, number and type of studies,
type of analysis, research period, interventions, outcomes,
3.1. Screening of S/M-R. In the initial search, 43 articles were risk of bias, and main results.
found, of which 36 articles were obtained by PubMed/
MEDLINE, five articles by Cochrane, and two studies by
manual search. Then, after reviewing the title, abstract, and 3.4. General Sample Analysis
inclusion/exclusion criteria, 17 studies were selected. Finally,
based on the full text of the articles, 14 S/M-R [44–57] were (i) The success rate of prosthetic restorations on ET
eventually included in our study (Figure 1). We collected the teeth: In three S/M-R [44, 51, 54], containing a total
S/M-R in three parts: prosthesis, success rate, and ET teeth number of 22 studies (RCTs [1], in vitro studies [12],
failure rate. The overall number of studies that were analyzed clinical trials [6], prospective studies [4], and ret-
in selected reviews and therefore included in our study was rospective studies [1]), the success rate was com-
118. pared. In one study [44], the five-year success rate
for endocrowns and conventional crowns was about
77% and 94%, respectively. Sedrez-Porto et al. [51]
3.2. Risk of Bias Assessment. We applied the Assessment of and Ploumaki et al. [54] also reported success rates
Multiple Systematic Reviews (AMSR2) tool to measure the of 92%, 79%, and 66% for single crowns, and fixed
risk of bias used for various studies. Based on the number of and removable prostheses, respectively.
International Journal of Dentistry 5

Table 3: Baseline characteristics of systematic reviews assessing the prosthetic restorations on endodontically treated teeth.
Overall
Types/no. of Method number of
Risk of
Author (year) studies of Search period Interventions samples Outcomes accessed Main results
bias
included analysis (restored
teeth)
Endocrowns is a
Evaluation of survival Restoration materials,
promising
Al-Dabbagh, 3 clinical trial/ Up to June and success of restoration methods,
SR/MA 376 Moderate restorative option
2020 [44] 7 in vitro 2019 endocrowns in ET survival rate, success
for ET posterior
teeth restoration rate, failure rate
teeth
Restorative
preferences related
to posts have
changed over time,
Preferences of
from cast posts to
dentists and students Type of posts
Girotto et al., Up to Nov prefabricated ones
25 SR/MA in choosing the type 600 Prefabricated posts Moderate
2020 [45] 2019 or the use of both
of restoration in ET Cast metal posts
posts. They seem to
teeth
be influenced by
experience and
postgraduate
training
Fiber posts
displayed higher
Fiber posts survival
medium-term
rate
overall survival rates
Metal posts survival
Wang et al., Up to Jan Fiber posts vs. metal than metal posts
4 RCTs SR/MA 223 rate Low
2019 [46] 2018 posts for restoration when used to restore
Success rates
ET teeth with no
Post debonding rates
more than two
Root fracture rates
coronal walls
remaining.
Ferrule effect and
Failure rates of post/ maintaining cavity
Postendodontic
core complexes with or walls are the
Naumann 7 RCTs treatment using posts
SR June 2017 1530 without ferrule Moderate predominant factors
et al., 2018 [47] 1 prospective with or without
support tooth and/or concerning tooth
ferrule
restoration survival and restoration
survival of ET teeth
Post- or crown
cementation
Influence of the
endodontic failure
number of remaining Should focus on the
Sarkis-Onofre crown/postfracture
9 RCTs SR 2004 to 2013 coronal walls, the use 1526 Low maintenance of the
et al., 2017 [48] crown dislodgements
or disuse of posts, and coronal structure
postdebonding rates
their type
clinical/radiographic
examination
The survival rates
against the fracture
of ET posterior teeth
restored with
1 RCTs Crowns or resin
crowns or resin
Suksaphar 1 Prospective composite for Survival rate against
SR 1980 to 2016 116 Low composites were not
et al., 2017 [49] 1 posterior teeth fracture
significantly
Retrospective restored
different in the teeth
with minimum to
moderate loss of
tooth structure
A correlation
between the failure
rates of fiber posts
Fiber posts and single
Failure rates of fiber and the type of
Sorrentino crowns or fixed
4 RCTs SR Up to 2015 117 posts prosthetic Low prosthetic
et al., 2016 [50] dental prostheses for
restorations restorations, just
restoration
like SCs and FDPs,
cannot be found to
date
6 International Journal of Dentistry

Table 3: Continued.
Overall
Types/no. of Method number of
Risk of
Author (year) studies of Search period Interventions samples Outcomes accessed Main results
bias
included analysis (restored
teeth)
Endocrown Endocrowns may
compared to perform similarly or
conventional Fracture strength better than the
Up to treatments endocrown conventional
Sedrez-Porto 3 Clinical trial
SR/M-A February (intraradicular posts, — restorations Low treatments using
et al., 2016 [51] 5 In vitro
2016 direct composite conventional intraarticular posts,
resin, and inlay/ restorations direct composite
onlay). For resin, or inlay/onlay
restorations restorations
There is insufficient
Catastrophic failure of
evidence to assess
restoration,
Sequeira- the effects of crowns
Up to March Single crowns versus noncatastrophic
Byron et al., I RCTs SR/MA — Low compared to
2015 conventional fillings failure of restoration,
2015 [52] conventional fillings
noncatastrophic
to restore root-filled
failure of post
teeth
Results did not show
Metal-based posts
Incidence rate related significant
survival rate fiber-
Figueiredo 7 RCTs Up to January to the use of metal differences for root
SR/MA 3202 reinforced posts Low
et al., 2015 [53] 7 Cohort 2014 posts was higher than fracture incidence
survival rate
that of fiber posts between metal and
catastrophic failures
fiber posts
Success rate of single
The success rates of The results of this
crowns success rates of
prosthetic systematic review
Ploumaki et al., 1 RCTs Up to June crowns over cast post
SR/MA restorations on 1206 Low should be
2013 [54] 3 Prospective 2012 and core success rates
endodontically interpreted with
of crowns over
treated teeth caution
prefabricated posts
CENTRAL to
2005
It is not specified
MEDLINE to
which type of post
September
Loss of retention, and core system
Bolla et al., 2005/Scopus Root canal posts for
2 RCTs SR/MA 317 postfracture root Low should be used
2007 [55] to December the restoration
fracture when two or three
2004
dentine walls
EMBASE to
remain
D
es 2004
RCTs restored with
crowns show an
Placement of a crown acceptable long-
Survival of RCT
Stavropoulou is associated with term survival of 10
restored with crowns
and Koidis, 10 RCTs SR/MA 1960 to 2006 improved (long term) — Moderate years, while direct
survival of RCT with
2007 [56] survival of root canal restorations have an
direct restorations
treated teeth excellent survival
only for a short
period.
Load-to-failure
No significant
Heydecke and 10 Clinical Single-rooted teeth Cast post
1995 and difference between
Peters 2002 trial SR/MA with cast or direct 1758 and core failure Moderate
2000 cast and direct posts
[57] 6 In vitro posts and cores Direct post and core
and cores
failure
SR: systematic review;/MA: meta-analysis; RCTs: randomized clinical trials.
International Journal of Dentistry 7

(ii) The success rate of single crowns in ET teeth re- and carbon fiber was twice as high as that of metal
stored with or without posts: Three S/M-R posts and fiberglass. In the review performed by
[45, 48, 54] including 34 studies were surveyed. Heydecke and Peters [57], the failure rate between
According to Ploumaki et al. [54], the success rates direct posts and direct post and cores was not
of single crowns on teeth without posts, with posts, significantly different. According to the study per-
with cast post and cores, and with prefabricated formed by Sorrentino et al. [50], the most frequent
posts were 94%, 92%, 93%, and 94%, respectively. failures in single crowns and fixed prostheses were
Sarkis-Onofre et al. [48] reported the success rate of caused by the separation of the fiber post, lack of
elastic posts from 71.8 to 100%. Girotto et al. [45] single crown retention, and marginal clefts. In
stated that the most frequently used posts were Sedrez-Porto et al. [51] study, the rate of failure in
firstly prefabricated and secondly metal posts with endocrowns was reported higher than that of
rates of 45.8% and 16.7%, respectively. They men- conventional methods. Ploumaki et al. [54] also
tioned time and training as factors affecting the reported postdebonding as the most common cause
decision of choosing prefabricated or metal posts. of failure.
(iii) Survival rate of single crowns on ET teeth: eight
S/M-R articles [44, 46–49, 53, 56, 57], listed in 4. Discussion
Table 3, including 48 RCT, 13 in vitro, 10 clinical
Due to controversy among studies on the success rate of
trials, and 2 prospective studies, provided infor-
endodontically treated teeth, the purpose of this umbrella
mation on survival. Based on the study performed
review was to compare the clinical evidence for the success
by Al-Dabbagh [44], the overall 5-year survival rates
and failure rates of restorations in endodontically treated
for endocrowns and conventional crowns were
teeth. Targets included fixed/removable prostheses and posts
91.4% and 98.3%, respectively. In the study per-
and the rate of success and failure in them. Data from 14
formed by Suksaphar et al. [49], the survival rate of
systematic reviews [44–57], which included 118 studies and
crowns was 94%, and the composite resin survival
more than 10971 samples altogether, were categorized based
rate was 91%. In addition, according to the study of
on the type of restoration.
Stavropoulou and Koidis [56], the 10-year survival
In 22 of the 118 studies, successful single crowns on ET
rates for crowns and direct restorations were 81%
teeth were reported exclusively [58–60]. Furthermore, in 34
and 63%, respectively. Suksaphar et al. [49] reported
studies, the success rate of single crowns on ET teeth was
that the survival rate of composite resin or crowns
compared with or without posts. The five-year success rate of
against fracture was nearly the same. Wang et al.
the endo-crown system was 94% [1, 3]. Eventually, the
[46] concluded that the survival rate of fiber posts
survival rate of ET teeth was associated with the remaining
was significantly higher than metal posts. They
crown structures and the type of restorative material. Both of
found that for root treatment with more than two
these play an important role in increasing the chance of
crowned walls, the medium-term survival rate of
long-term dental survival. Based on clinical studies, a single
fiber posts was higher than metal posts. Figueiredo
crown is the best treatment for ET teeth. However, high-
et al. [53] reported that the survival rates of metal
quality clinical evidence on this subject is required due to the
posts and fiber posts were 90% and 83.9%, re-
limited number of data available.
spectively. In addition, the survival rate of cast post
Within the systematic review studies, the results from
and cores in the study by Heydecke and Peters [57]
four studies were about fixed and removable prostheses.
ranged from 87.2% to 88.1%. Naumann et al. [47]
Thirty-four studies reported postrestoration success. The
also stated in their study that ferrule increases the
success rate for ET teeth [58] after six years was 94–92%.
survival rate of endodontic-treated teeth by pre-
Furthermore, the success rate for fixed and removable
serving cavity walls. According to Sarkis-Onofre
prostheses was 78% and 66%, respectively. In general, single
et al. [48], teeth without ferrule also showed a higher
crowns perform better than other prosthetic restorations
variation in the survival rate (0%–97%) compared to
[28, 61]. This is because the dental stresses in fixed and
teeth with ferrule.
removable dentures are more than single crowns [28]. Be-
(iv) Failure rate: The six S/M-R [46, 50, 51, 53, 54, 57] sides, removable dentures should also be reinforced with
listed in Table 3 contained 48 studies including posts [13, 28]. According to the results of the review studies,
RTCs [14], in vitro studies [11], clinical trials [13], the success rate for prefabricated posts was higher than cast/
prospective studies [3], and cohorts [7]. They re- core posts. Clinically, however, dentists engage in cast/core
ported failure rates in their systematic reviews. posts when dealing with moderate to high tissue loss.
According to Wang et al. [46], the success rate, Findings from various studies show that nonmetallic fiber
postdebonding rate, or root fracture rate between posts work better than metal posts [55, 62, 63]. However, the
fiber posts and metal posts were not significantly overall evidence in this area is relatively weak and should be
different. Moreover, according to the study by interpreted more accurately.
Figueiredo et al. [53], the rate of root fractures in One of the tools to assess the quality and bias of studies is
metal and fiber posts was similar. Furthermore, the the AMSTAR tool, which is designed based on responses to a
rate of root fractures in prefabricated metal posts standard set of questions. It is necessary to correctly
8 International Journal of Dentistry

interpret the information to use quality measurement tools [9] E. S. Reeh, H. H. Messer, and W. H. Douglas, “Reduction in
and determine the S/M-R proficiency level. However, during tooth stiffness as a result of endodontic and restorative
this assessment, the Funding Sources parameter in the text procedures,” Journal of Endodontics, vol. 15, no. 11,
was not indicated. Therefore, more attention to this issue is pp. 512–516, 1989.
recommended in articles. Despite the limitations of this [10] L. W. M. Van der Sluis, M.-K. Wu, and P. R. Wesselink, “The
efficacy of ultrasonic irrigation to remove artificially placed
study, we evaluated the results of several systematic reviews
dentine debris from human root canals prepared using in-
comprehensively and tried to eliminate some controversies struments of varying taper,” International Endodontic Journal,
among their results. Nevertheless, more investigation is vol. 38, no. 10, pp. 764–768, 2005.
recommended in this regard to draw a more reliable con- [11] T. Y. Huang, K. Gulabivala, and Y. L. Ng, “A bio-molecular
clusion for clinicians. film ex-vivo model to evaluate the influence of canal di-
mensions and irrigation variables on the efficacy of irriga-
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pp. 60–71, 2008.
It appears that one of the most reliable ways to restore ET [12] L. H. Berman and K. M. Hargreaves, Cohen’s Pathways of the
teeth is to apply single crowns and endocrowns. However, Pulp Expert Consult, Elsevier Health Sciences, Amsterdam,
more consistent studies are required to present the reported Netherlands, 2015.
[13] I. Peroz, F. Blankenstein, K. P. Lange, and M. Naumann,
findings more confidently. Even considering the potential
“Restoring endodontically treated teeth with posts and cores--
for bias, the level of evidence available for the use of this a review,” Quintessence International, vol. 36, no. 9,
clinical method is high. pp. 737–46, 2005.
[14] C. J. Goodacre and K. J. Spolnik, “The prosthodontic man-
Conflicts of Interest agement of endodontically treated teeth: a literature review.
Part I. Success and failure data, treatment concepts,” Journal
The authors declare no conflicts of interest. of Prosthodontics, vol. 3, no. 4, pp. 243–250, 1994.
[15] R. Schwartz and J. Robbins, “Post placement and restoration
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