UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4114
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Braz Dent Sci 2024 Jan/Mar; 27 (1): e4114
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
Longevidade clínica de pinos intraradiculares metálicos versus de fibra de vidro: uma revisão sistemática
Carolina Menezes MACIEL1 , Kusai BAROUDI2 , Kamilla Carolina Feitosa OLIVEIRA3 , Cleydiane dos SANTOS3 ,
Carina Santos LIMA3 , Rafael Pino VITTI4
1 - Universidade Federal de Sergipe, Departamento de Odontologia. Lagarto, SE, Brazil.
2 - RAK Medical and Health Sciences University, RAK College of Dental Sciences. Ras Al Khaimah, United Arab Emirates.
3 - Universidade Tiradentes, Departamento de Odontologia. Aracaju, SE, Brazil.
4 - Fundação Hermínio Ometto. Araras, SP, Brazil.
How to cite: Maciel CM, Baroudi K, Oliveira KCF, Santos C, Lima CS, Vitti RP. Clinical longevity of metallic versus berglass intraradicular posts:
a systematic review. Braz Dent Sci. 2024;27(1):e4114. https://doi.org/10.4322/bds.2024.e4114
ABSTRACT
Objective: This systematic review aims to compare the clinical longevity of metallic and berglass intraradicular posts
in teeth with severely compromised crowns, utilizing randomized clinical trials and case reports published in the last
eleven years. Material and Methods: The research was conducted on PubMed, Medline, Lilacs, and BBO databases using
the rst search strategy with the descriptors ‘dental posts,’ ‘longevity,’ ‘berglass-reinforced posts’ or ‘metallic posts.’
The second search strategy involved analyzing the references of articles identied by the rst search. Both studies were
carried out with stringent inclusion and exclusion criteria. Results: No statistically signicant and clinically relevant
differences in longevity were observed between metallic and berglass posts. Conclusion: The clinical success and
durability of the restorative procedure using intraradicular posts primarily depend on the remaining amount around
the post (ferrule), the type and position of the tooth in the arch (impacting the masticatory forces exerted on the
restored tooth), and the correct application of the cementation technique. It is noteworthy that berglass posts offer
substantial advantages by presenting a modulus of elasticity similar to dental structure, ensuring a more homogeneous
distribution of masticatory forces and reducing the risk of fractures. These ndings have practical implications for
material selection in restorative procedures involving intraradicular posts.
KEYWORDS
Dental materials; Dental post; Fiberglass posts; Longevity; Post and core technique.
RESUMO
Objetivo: Esta revisão sistemática visa comparar a longevidade clínica de pinos intrarradiculares metálicos e de bra
de vidro em dentes com coroas severamente comprometidas, através de estudos clínicos randomizados e relatos
de casos, publicados nos últimos onze anos. Material e Métodos: A pesquisa foi conduzida nas bases de dados
PubMed, Medline, Lilacs e BBO, utilizando a primeira estratégia de busca com os s ‘pinos dentais’ e ‘longevidade’
e ‘pinos reforçados com bra de vidro’ ou ‘pinos metálicos’. A segunda estratégia de busca consistiu na análise das
referências dos artigos identicados pela primeira estratégia. Ambos os estudos foram delineados com critérios rigorosos
de inclusão e exclusão. Resultados: Não se constataram diferenças estatisticamente signicativas e clinicamente
relevantes na longevidade entre pinos metálicos e de bra de vidro. Conclusão: O êxito clínico e a durabilidade
do procedimento restaurador empregando pinos intrarradiculares dependem primordialmente da quantidade de
remanescente ao redor do pino (férula), do tipo e posição do dente na arcada (o que impacta nas forças mastigatórias
exercidas sobre o dente restaurado) e da aplicação correta da técnica de cimentação.Destaca-se que o pino de bra de
vidro oferece vantagens substanciais ao apresentar módulo de elasticidade similar à estrutura dentária, assegurando
uma distribuição mais homogênea das forças mastigatórias e reduzindo o risco de fraturas.
PALAVRAS-CHAVE
Materiais dentários; Pinos dentários; Pinos de bra de vidro; Longevidade; Técnica de pinos e núcleos.
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Braz Dent Sci 2024 Jan/Mar; 27 (1): e4114
Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
INTRODUCTION
When dental units are submitted to
endodontic therapy and present great loss of
coronary structure, the adoption of a restorative
procedure associated with retention strategies
for extensive restorations is suggested [1].
In dentistry, intraradicular posts are commonly
used to improve the retention of direct and/or
indirect restorations. They can be prefabricated
or customized, according to the root canal
anatomy, and vary in shape, length, diameter,
and material type. Among the various material
options for intraradicular posts, cast metal cores
and berglass posts stand out [2].
Cast metal cores are fabricated from
various metal alloys, including nickel-chromium,
silver-palladium, and copper-aluminum.
Customized cores are widely recommended
in clinical practice due to their high fracture
resistance and excellent adaptation to the root
canal [1,3]. However, intraradicular metallic
posts are susceptible to corrosion in dental
science, a complex issue inuenced by factors
such as oral environment dynamics, material
composition, and patient-specific conditions.
Galvanic corrosion and pitting contribute to
post-degradation, affecting both the aesthetics
and functionality of dental restorations. Clinical
implications include potential microleakage,
posing a risk to periapical health [1,3].
Fiberglass posts, besides offering a more
aesthetically pleasing alternative for restorative
rehabilitation, possess a modulus of elasticity and
rigidity similar to that of the dentinal substrate,
thereby reducing the risk of fracture [4,5].
Notably, the absence of the corrosion process and
the reduced necessity to remove dental tissue for
adaptation, when compared to metallic posts,
suggests that berglass posts may contribute to
greater clinical longevity for restorations [6].
The clinical longevity of a post is directly
related to its resistance to stresses and correct
installation protocol. However, the stiffness of
the intraradicular post material for a long time
has been described as a factor that can increase
the tooth’s susceptibility to root fracture. This
factor is associated with metallic posts, as stated
by Sarkis-Onofre et al. [7], inferring that these
posts have a high elastic modulus compared
to the dentin substrate, increasing the risk of
root fracture and failure of the rehabilitation
treatment. In other words, in case of overload, the
dentin fractures before the intraradicular post due
to the great difference between the elastic moduli.
Ghavamnasiri et al. [8] mention that the post
must have a modulus of elasticity similar to that
of resin cement or the dentin that surrounds it, to
optimize the result of the restoration’s longevity.
Despite the many advantages of berglass
posts, metallic posts are still widely used and
the discussion about the most suitable post
type for restoration of tooth structure remains
controversial [7,9]. The originality of this work
aims to compare, through a systematic review
of literature, the clinical longevity of metal and
berglass posts, using randomized clinical studies
and clinical case reports, which monitored clinical
longevity for at least 3 years.
METHODOLOGY
This systematized review was conducted
according to the criteria established by Cochrane.
The methodology standardized the search for
scientific papers that evaluated the clinical
longevity of metallic cores and/or posts and
berglass posts. The studies could report results
of evaluations of only one of the materials or a
comparison of longevity between them.
The rst search strategy was performed using
PubMed, Medline, Lilacs, and BBO databases to
identify potentially relevant studies. The search
descriptors were: ‘dental posts’ and ‘longevity’
and ‘glass ber reinforced posts’ or ‘cast posts’.
The second search strategy occurred through
the references of the articles found by the rst
search strategy. In both surveys, inclusion and
exclusion criteria were applied.
Inclusion criteria
As inclusion criteria, only studies in the
English language, published in full in the last
11 years (January 2010 to September 2021),
whether case reports and/or randomized clinical
trials (retrospective or prospective), were
included.
Since metallic retainers have relevant
long-term clinical success considerations, the
objective of selecting only works published in
the last eleven years was the analysis of articles
referring to berglass posts that already included
studies using materials with quality in the
adhesive cementation of berglass posts.
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Braz Dent Sci 2024 Jan/Mar; 27 (1): e4114
Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
As there are already many laboratory comparisons
in the literature of the materials used as intraradicular
retainers, for this systematic review, only studies
carried out with humans (in vivo) were included and
that analyzed the clinical longevity of cores, and/or
posts, metallic and berglass posts. glass.
Exclusion criteria
For the data analysis to be more standardized,
some exclusion criteria for the studies were also
applied. Table I shows all used.
Selection of articles
All articles found underwent a sequential
reading of the title and abstract, to assess whether
they contained the topic of discussion proposed
by this review, and the inclusion and exclusion
criteria were applied. All texts were read and
selected by two independent reviewers. Eventual
conicts between reviewers were discussed and
subsequently resolved by consensus with a third
reviewer.
The rst search strategy, through the databases,
was carried out in two moments: 17.08.2020,
moment 1; and updated on 9/23/2021, moment 2).
The second search strategy occurred through the
analysis of all bibliographical references belonging
to the articles obtained from the rst strategy.
RESULTS
At the moment 1 of the search strategy, 171
articles were obtained, of which 7 were selected
according to the inclusion and exclusion criteria.
At moment 2, 458 articles were collected, but
only two t the inclusion and exclusion criteria,
in addition to having already been obtained in the
search at moment 1. Thus, the total number of
articles selected for this systematic review was 7.
Table II describes the rst strategy with both
moments (1 and 2) of the searches, detailing in
each database the number of articles found and
discarded, according to the aforementioned criteria.
In Table III there is a description within each
of the rst seven articles selected: total references
cited, how many were discarded, and how many
were selected for inclusion in this systematized
review. By applying the inclusion and exclusion
criteria, 7 new references were obtained for this
work. Table IV shows the details of the references
of articles discarded by the second search strategy,
with the reasons for exclusion.
Thus, for the systematic analysis proposed by
this study, 14 articles were selected, all involving
analysis of longevity of restorations associated
with metal (PM) and/or berglass (PF) posts,
with 8 prospective and 5 retrospective studies.
The summary of the methodological guidelines is
described in Figure 1 according to Preferred Reporting
Items for Systematic Reviews and Meta-Analyses
(PRISMA). Table V follows the description of these
articles concerning the author/year, type of study,
which post was evaluated, what time the study was
analyzed, which parameters for longevity used by
the study, and summary conclusion.
Among the prospective articles that evaluated
only FP [4,12-14], the results showed that this type
of post increased the survival of rehabilitated teeth.
Table I - Description of exclusion criteria
Literature review
In vitro studies
Studies with extracted teeth
Studies performed on 3D models
Studies performed with non-human teeth
Studies conducted via surveys
Articles with themes unrelated to dentistry
Articles in languages other than English.
Articles on other topics in dentistry
Abstract not available
Case report without longevity assessment
Case report with assessment of short-term longevity (less than three years)
Systematic reviews with or without meta-analysis
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
Table II - Result of the first search strategy
First search strategy
(‘dental posts’ and ‘longevity’ and ‘glass fiber reinforced posts’ or ‘cast posts’)
Moment 1
Platform Articles Found Articles Disposed Selected Articles
PubMed 162 155 7
Medline 6 6 0
Lilacs/BBO 3 3 0
Moment 2
Platform Articles Found Articles Disposed Selected Articles
PubMed 443 288 2
Medline 6 6 0
Lilacs/BBO 9 9 0
Table III - The result of the second search strategy
Second search strategy
Search in the references of articles selected by the first strategy
Author Number of references Number of selected studies Number of excluded studies
Gomez-Poloetal. [1] 40 0 40
Zicarietal. [10] 22 0 22
Sarkis-Onofreetal. [9] 33 2 31
Parisietal. [4] 44 1 43
Cloetetal. [2] 50 2 48
Sarkis-Onofreetal. [7] 23 0 23
Martinoetal. [11] 44 2 42
TOTAL 234 7 227
Table IV - Detailing of the references of the articles disposed by the second search strategy
AUTHORS
Gomez-
Polo
etal.
[1]
Zicari
etal.
[10]
Sarkis-
Onofre
etal.
[9]
Parisi
etal.
[4]
Cloet
etal.
[2]
Sarkis-
Onofre
etal.
[7]
Martino
etal.
[11]
TOTAL
LITERATURE REVIEW 0 1 9 1 1 14 9 34
MORE THAN 10 YEARS REFERENCE 40 16 15 32 46 3 29 165
EXTRACTED TEETH 0 4 0 6 0 1 2 9
IN VITRO STUDIES 0 1 0 3 0 0 0 3
3D MODELS 00010001
ARTICLES ALREADY PREVIOUSLY SELECTED 0 0 3 0 1 4 2 10
DIVERGENT THEMES 0 0 4 0 0 1 0 5
TOTAL 40 22 31 43 48 23 42 227
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
Figure 1 - Preferred Reporting Items for this Systematic Review according to PRISMA.
Table V - Description of selected studies - author/year, type of study, which post was evaluated, time of study analysis, which parameters for
longevity used by the study, summary conclusion
AUTHOR/
YEAR STUDY TYPE MATERIAL LONGEVITY
ANALYSIS
TYPE OF LONGEVITY
ANALYSIS CONCLUSION
Gómez-Polo
etal. [1]
Randomized clinical trial
pfMP and CMP 10,08 years
It was considered a failure: CMP >pfMP
Prospective study - Clinical or radiographic
signs of failure
- Teeth in need of extraction Success rate:
CMP: 84,6%
pfMP: 82,6%
Legend: FP = Fiber Glass Post; CFP = Customized Fiber Post; pfMP = Pre-Fabricated Metallic Post; CMP = Cast Metallic Post.
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
AUTHOR/
YEAR STUDY TYPE MATERIAL LONGEVITY
ANALYSIS
TYPE OF LONGEVITY
ANALYSIS CONCLUSION
Mancebo
etal. [12]
Randomized clinical trial
FP 3 years
Every 6 months analysis 16.1% of restorations failed.
Prospective study
The success rate was always
evaluated by at least the
operator
Causes:
Parameters: - Carious lesions
- Visual inspection with
magnifying glasses - Post fracture
- Examination of the
restoration margins - Root fracture
- Intraoral Photographic
Examinations - Post-cementation failure
- Failure to cement the
crown
- Periapical lesions.
The incisors had a higher
failure rate (26.5%). Among
premolars, the failure rate
was 8%, and among molars,
18.8%.
Ghavamnasiri
etal. [8]
Randomized clinical trial
FP From 1 to 6
years
Clinical examinations were
performed by two different
examiners.
The success of the
treatment is linked to
the location of the teeth.
Maxillary teeth had a
higher failure rate when
compared to mandibular
teeth. In one case, the
composite resin fractured
after 4 years of clinical
service, and another
fractured after 6 years.
This variation might be
due to each case being
subjected to different
forces depending on the
location in the mouth,
texture of the diet, oral
habits, bruxism, occlusal
relationships, or restoration
design.
Prospective study
Success was analyzed
through clinical and
radiographic examinations.
Zicari etal.
[10]
Randomized clinical trial pfMP and CMP
7 to 37
months
The flaws were:
After being followed for
up to 3 years, both the
composite core and powder
systems were clinically well
performed.
Prospective study CFP
- Absolute, such as root
fractures or irreparable
post/core fractures,
- Or relative, such as
post-retention loss of
retention or repairable core
fractures.
Longer studies are
needed to detect possible
differences.
Ferrari etal.
[13]
Controlled clinical trial.
Prospective study FP and CFP 6 years Clinical e-radiographic
follow-up
The analysis revealed that
PF increased tooth survival.
The failure rate was lower
in teeth with prefabricated
posts than with custom
posts.
Legend: FP = Fiber Glass Post; CFP = Customized Fiber Post; pfMP = Pre-Fabricated Metallic Post; CMP = Cast Metallic Post.
Table V - Continued...
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
AUTHOR/
YEAR STUDY TYPE MATERIAL LONGEVITY
ANALYSIS
TYPE OF LONGEVITY
ANALYSIS CONCLUSION
Naumann M.
etal. [14]
Randomized clinical trial
FP 5,3 years
Clinical and radiographical
exams during the follow-up
period
The most frequently observed
failures were: post-fracture,
loss of post retention, and
endodontic problems that
resulted in tooth extraction.
Prospective study
As for the type of tooth,
posterior teeth showed
better results compared to
the anterior ones.
The number of walls
remaining in the cavities also
influenced the success rate,
cavities with higher numbers
of walls had better results.
Sterzenbach
etal. [15]
Randomized clinical trial
FP and CMP 7 years Clinical e-radiographic
follow-up
When self-adhesive cement
was used, prefabricated posts
in severely destroyed teeth
increased the success rate of
restorations, regardless of the
material used.
Prospective study
Sarkis-Onofre
etal. [9]
Randomized clinical trial
FP and CMP 3 years Clinical e-radiographic
follow-up
FP = CMP
Prospective study
Average longevity 30.1 months
Parisi
etal. [4] Retrospective analysis FP
From 7
months to
9,25 years
Clinical follow-up and
success or failure were
correlated with tooth
location, and whether
there was permanent or
temporary restoration.
FP success rate was 85%
The average longevity of 6
years for FPs.
The high incidence of failures
related to the adhesive
technique showed that this
aspect should be improved.
The high incidence of
failures in maxillary posterior
teeth demonstrates the
need to use less sensitive
cementation techniques
Raedel
etal. [3] Cohort study CMP 19,5 years
The assessment was carried
out through electronic
medical records.
CMP has acceptable long-
term success rates.
The longevity assessment
was correlated with the
type of tooth, the position
of the tooth in the arch, and
the presence or absence of
adjacent teeth
The presence of adjacent
teeth increases MP survival.
The use of fixed dentures
can have a positive influence
on tooth survival. Likewise,
the use of this tooth as an
abutment for fixed partial
dentures can reduce the
tooth’s survival time.
Legend: FP = Fiber Glass Post; CFP = Customized Fiber Post; pfMP = Pre-Fabricated Metallic Post; CMP = Cast Metallic Post.
Table V - Continued...
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
AUTHOR/
YEAR STUDY TYPE MATERIAL LONGEVITY
ANALYSIS
TYPE OF LONGEVITY
ANALYSIS CONCLUSION
Cloet
etal. [2]
Randomized clinical trial
FP and CMP 5,8 years
The restorations were
examined clinically and
radiographically. Antagonist
status, marginal integrity,
periodontal health,
occlusion, and TMJ patterns
were evaluated.
FP = CMP
Prospective study
Naumann
etal. [16]
Randomized clinical trial
FP and CMP 11 years
Clinical and radiographic
examinations were
performed during follow-up.
When self-adhesive cement,
prefabricated posts, and
resin cores are used, the
rigidity of the material
becomes irrelevant.
Prospective study
Survival rate declined
rapidly after 8 years in
severely destroyed teeth,
especially in teeth with FP.
Sarkis-Onofre
etal. [7]
Randomized clinical trial
FP and CMP
Mean 5 years
Clinical and radiographic
exams
FP = CMP
Prospective study
From
12 months to
9 years
Longevity up to 9 years
Martino
etal. [11] Retrospective analysis pfMP and FP
5 years
Digital database analysis
was performed. Medical
records that contained
sufficient information
recorded were analyzed
and clinical or radiographic
confirmation of the
presence of the post was
performed.
(Jan. 2013 –
jan. 2018) FP = CMP= pfMP
Longevity:
· FP (12 years)
· CMP (11,8years)
· pfMP (10,2 years)
Legend: FP = Fiber Glass Post; CFP = Customized Fiber Post; pfMP = Pre-Fabricated Metallic Post; CMP = Cast Metallic Post.
Table V - Continued...
It was considered that the presence of a splint,
in a range of 1.5 to 2mm, provides more
resistance to fracture and increases the survival
of endodontically treated teeth, when restored
with adhesive technique and berglass posts.
Prospective analyses that compared CMP with
PFs [2,7,9,10,15,16] unanimously inferred that
both types of posts had similar mean longevity, with
a report of up to 9 years of follow-up, regardless of
tooth location.
Only one retrospective study [11] compared
the survival rate between CMP and FP by
analyzing medical records over 5 years. It was
concluded that there was no signicant evidence
relating the survival rate to the type of post, but
the authors mentioned that prefabricated metal
posts have a slightly higher risk of failure. That
same study found that the percentage of root in
bone, tooth position, cement type, and restoration
type were associated with survival rates. The
FP had a slightly longer longevity, 12 years,
compared to the MP, which was 11.8 years.
Retrospective studies by Gomez-Polo et al. [1]
and Raedel et al. [3], who evaluated only CMP,
revealed a high long-term success rate (over
10 years), especially when adjacent teeth are
present.
Regarding the retrospective studies that
evaluated only the longevity of FP [4,8], the
longevity of up to 6 years was noted and suggested
that the rehabilitation of teeth with FP can be
considered a reliable procedure, with a high
survival rate. Concerning failures, they were
associated with problems arising from endodontic
treatments, assuming that the cementation
technique had a well-executed adhesion stage.
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Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
DISCUSSION
From this systematic review, it can be
observed that studies that evaluated only the
clinical longevity of metallic posts demonstrated
high success rates, for follow-up periods longer
than 10 years [1,3]. Comparative studies between
PM and PF [2,7,9-11,15,16] demonstrated that
metallics obtained a survival rate similar to
fiberglass. Other authors [4,5] disagree with
these results because they adhere to the theory
that fiber posts are the most viable option in
rehabilitation, especially when compared to
CMP, due to the biomechanical behavior similar
to dentin, absorbing the tensions generated by
masticatory forces and protecting the remaining
root, thus minimizing irreversible root fractures.
For these authors, FP failures are related to errors
in cementation. It is important to emphasize that
adhesive cementation is much more sensitive
to errors than micromechanical cementation,
performed for CMP [17].
Although the cast metal post has already
been established as a good and efcient material
in dentistry, with the advancement of adhesive
dentistry there is a tendency for dentists to use
FP; because, despite the greater sensitivity of the
technique, the work time and cost is reduced, as
it does not require a laboratory stage. With FPs,
in addition to improving aesthetics, ber posts
reduce the incidence of root fractures, as they
also preserve a greater amount of tooth structure
and elastic modulus similar to dentin. Its xation
is based on the principles of adhesion, without
the need for greater wear for a micromechanical
xation, as it works for metallic retainers [4,5,14].
Another factor cited as relevant for the
success of intraradicular posts is the amount of
remaining splint. A direct relationship has been
demonstrated between the amount of coronal
tooth structure remaining and the tooth’s ability
to resist occlusal forces. As more tooth structure
is removed, the ability to resist occlusal forces
is reduced. And it is based on this foundation
that Ferrari et al. [13] pointed out that the risk
of failure increases when the dental units, that
received intraradicular posts, do not have the
ferrule. Mancebo et al. [12] emphasized that the
dentin collar at the root embouchure, with at least
2mm, provides greater resistance to fracture of
the restoration.
However, some studies do not relate the
survival rate to the type of post [2,7,9,11,16].
The study by Martino et al. [11] indicated that
cast metal cores have longer survival when they
are located in posterior teeth than when located
in anterior teeth. For the authors, the angulation
of the anterior teeth can be a justifying factor
for the failure results. Corazza et al. [18] stated
that metal posts appear to be more suitable for
weakened teeth because they can tolerate higher
masticatory forces when restored with metal
posts. Naumann et al. [14] stated that incisors
and canines have twice the failure rate when
compared to molars and premolars. The anterior
teeth, especially the maxillaries, are exposed to
more horizontal forces and stress zones, which
cause fractures due to fatigue. Therefore, the
anterior area of the maxilla is considered a
high-risk failure zone.
Unlike posterior teeth, which, when in balanced
occlusion, are subjected to unidirectional forces,
anterior teeth are subjected to multidirectional
forces. Thus, when they are overloaded by
excursive mandibular movements, they result
in a greater risk of fractures, especially when
restored with metallic posts, due to the very
difference in the modulus of elasticity of the
metals with dentin. The result of the study by
Sterzenbach et al. [15], states that although the
success rates of metal posts and berglass posts
are similar to each other, the type of material
was decisive in the way the masticatory forces
were dissipated. Teeth restored with metal
posts present high levels of stress concentrated
in the post, which can lead to fracture or micro
gap formation and, consequently, bacterial
colonization with periapical lesions. However,
the study by Parisi et al. [4] states that, although
theoretically anterior teeth have greater chances
of failure due to the forces on them, posterior
teeth have higher failure rates due to greater
technical difficulty in carrying out correct
endodontic treatment and correct positioning of
the posts in multi-rooted teeth.
It is necessary to highlight the existence
of studies on the clinical longevity of posts
regardless of the material and its rigidity [14],
and that the survival rate does not depend on
the position of the tooth in the arch either [7,9].
Sterzenbach et al. [15] claimed that the main
factor for rehabilitative success is the cementing
agent. Even in severely destroyed teeth, when
self-adhesive cement was used, the success rate
of restorations was high, regardless of whether
the post was FP or CMP.
10
Braz Dent Sci 2024 Jan/Mar; 27 (1): e4114
Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
Due to many comparisons and different results
with analyses that do not have standardization of
materials, cement, location, and type of tooth,
new long-term clinical evaluation studies would
be necessary for a more reliable conclusion of
which material, PF or PM, is safer to be used
as intraradicular retainers. Many other factors
affect clinical longevity, which goes beyond the
post material, such as the patient’s occlusion, the
amount of remaining structure, and the presence
or absence of a ferrule [2,13-15]. It is noteworthy
that the presence of intraradicular posts regardless
of their composition material generates wear in
the tooth structure and tensions that can induce
fractures and reduce the longevity of restorations.
Being restored with an intraradicular post,
whether metallic or berglass, does not mean that
the restoration and/or the tooth are reinforced
[19,20]. Recent studies [21-24] have defended the
efciency of restorations without the presence of
intraradicular posts. Sáry et al. [23] pointed out
that restorations can be reinforced with berglass
or polyethylene strips, an alternative to increase
the longevity of extensive restorations. This new
technique can provide fracture resistance, acting as
a core, without the need for intraradicular wear for
the insertion of material. The reinforcement is under
a layer of resin composite, absorbing masticatory
tensions, without compromising aesthetics and
eliminating the need for intraradicular posts. They
are called biomimetic restorations because they
use materials with a modulus of elasticity similar
to the tooth structure, mimicking their substrates
and preserving their structure as much as possible
[21-24].
CONCLUSIONS
It should be understood that the clinical
success and longevity of the restorative procedure
using intraradicular posts depends much more
on the amount of remnant around the post
(splint), type and position of the tooth in the arch
(which will inuence the masticatory forces that
are exerted on the restored tooth) and correct
cementation technique.
Through this systematic review, no relevant
statistical differences were observed in the
longevity of metallic and berglass posts. However,
it cannot be denied that the PF has a greater
advantage in the choice because it has an elastic
modulus similar to the tooth structure, which
ensures a distribution of masticatory forces with
less overload on the tooth structure, in addition
to requiring less wear and aesthetics.
While improving and spreading the “new era”
of biomimetic restorations, many professionals
will continue restoring with intraradicular posts,
and, therefore, the entire restorative procedure
must be carefully executed, as clinical success
depends on much the correct execution of all steps
of the restorative technique rather than the type
of material of choice for the intraradicular posts.
Author’s Contributions
CMM: Writing – Review & Editing. KB:
Writing – Review & Editing. KCFO: Writing –
Original Draft Preparation. CS: Writing – Original
Draft Preparation. CSL: Writing – Original Draft
Preparation. RPV: Writing – Review & Editing.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
Funding
Nothing to declare
Regulatory Statement
Nothing to declare.
REFERENCES
1. Gómez-Polo M, Llidó B, Rivero A, Del Rio J, Celemín A. A 10-year
retrospective study of the survival rate of teeth restored
with metal prefabricated posts versus cast metal posts and
cores. J Dent. 2010;38(11):916-20. http://dx.doi.org/10.1016/j.
jdent.2010.08.006. PMid:20713117.
2. Cloet E, Debels E, Naert I. Controlled clinical trial on the outcome
of glass fiber composite cores versus wrought posts and cast
cores for the restoration of endodontically treated teeth: a
5-year follow-up study. Int J Prosthodont. 2017;30(1):71-9.
http://dx.doi.org/10.11607/ijp.4861. PMid:28085986.
3. Raedel M, Fiedler C, Jacoby S, Boening KW. Survival of
teeth treated with cast post and cores: a retrospective
analysis over an observation period of up to 19.5 years.
J Prosthet Dent. 2015;114(1):40-5. http://dx.doi.org/10.1016/j.
prosdent.2014.08.017. PMid:25862272.
4. Parisi C, Valandro LF, Ciocca L, Gatto MR, Baldissara P. Clinical
outcomes and success rates of quartz fiber post restorations:
a retrospective study. J Prosthet Dent. 2015;114(3):367-72.
http://dx.doi.org/10.1016/j.prosdent.2015.03.011. PMid:26013066.
5. Subash D, Shoba K, Aman S, Bharkavi SKI, Nimmi V, Abhilash R.
Fracture resistance of endodontically treated teeth restored
with, resin modified GIC and hybrid composite resin as a core
material. J Clin Diagn Res. 2017;11(9):ZC68-70. http://dx.doi.
org/10.7860/JCDR/2017/28263.10625. PMid:29207837.
11
Braz Dent Sci 2024 Jan/Mar; 27 (1): e4114
Maciel CM et al.
Clinical longevity of metallic ver sus fiberglass intr aradicular posts: a systematic re view
Maciel CM et al. Clinical longevity of metallic versus fiberglass intraradicular posts:
a systematic review
6. Kaur J, Sharma N, Singh H. In vitro evaluation of glass fiber post.
J Clin Exp Dent. 2012;4(4):e204-9. http://dx.doi.org/10.4317/
jced.50737. PMid:24558556.
7. Sarkis-Onofre R, Postheiro HA, Poletto-Neto V, Bergoli CD, Cenci
MS. Randomized controlled trial comparing glass fiber posts
and cast metal posts. J Dent. 2020;96:103334. http://dx.doi.
org/10.1016/j.jdent.2020.103334. PMid:32302640.
8. Ghavamnasiri M, Maleknejad F, Ameri H, Moghaddas MI,
Farzaneh F, Chasteen JE. A retrospective clinical evaluation of
success rate in endodontic-treated premolars restored with
composite resin and fiber reinforced composite posts. J Conserv
Dent. 2011;14(4):378-82. http://dx.doi.org/10.4103/0972-
0707.87203. PMid:22144807.
9. Sarkis-Onofre R, Jacinto RC, Boscato N, Cenci MS, Pereira-Cenci
T. Cast metal vs. glass fiber posts: a randomized controlled
trial with up to 3 years follow up. J Dent. 2014;42(5):582-7.
http://dx.doi.org/10.1016/j.jdent.2014.02.003. PMid:24530920.
10. Zicari F, Van Meerbeek B, Debels E, Lesaffre E, Naert I. An up to
3-year controlled clinical trial comparing the outcome of glass
fiber posts and composite cores with gold alloy-based posts
and cores for the restoration of endodontically treated teeth.
Int J Prosthodont. 2011;24(4):363-72. PMid:21716975.
11. Martino N, Truong C, Clark AE, O’neill E, Hsu SM, Neal D,etal.
Retrospective analysis of survival rates of post-and-cores in
a dental school setting. J Prosthet Dent. 2020;123(3):434-41.
http://dx.doi.org/10.1016/j.prosdent.2019.05.003.
PMid:31353108.
12. Mancebo JC, Jimenez-Castellanos E, Canadas D. Effect of tooth
type and ferrule on the survival of pulpless teeth restored with
fiber posts: a 3-year clinical study. Am J Dent. 2010;23(6):351-6.
PMid:21344836.
13. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi
L,etal. A randomized controlled trial of endodontically treated
and restored premolars. J Dent Res. 2012;91(7, Suppl):72S-8S.
http://dx.doi.org/10.1177/0022034512447949. PMid:22699672.
14. Naumann M, Koelpin M, Beuer F, Meyer-Lueckel H. 10-year
survival evaluation for glass-fiber–supported postendodontic
restoration: a prospective observational clinical study. J Endod.
2012;38(4):432-5. http://dx.doi.org/10.1016/j.joen.2012.01.003.
PMid:22414824.
15. Sterzenbach G, Franke A, Naumann M. Rigid versus flexible
dentine-like endodontic posts—clinical testing of a biomechanical
concept: seven-year results of a randomized controlled clinical
pilot trial on endodontically treated abutment teeth with severe
hard tissue loss. J Endod. 2012;38(12):1557-63. http://dx.doi.
org/10.1016/j.joen.2012.08.015. PMid:23146637.
16. Naumann M, Sterzenbach G, Dietrich T, Bitter K, Frankenberger
R, Von Stein-Lausnitz M. Dentin-like versus rigid endodontic
post: 11-year randomized controlled pilot trial on no-wall to
2-wall defects. J Endod. 2017;43(11):1770-5. http://dx.doi.
org/10.1016/j.joen.2017.06.030. PMid:28951033.
17. Michida SMA, Dal Piva AMO, Tribst JPM, Souza ROA, Lombardo
GHL, Bottino MA, et al. Resin push-out bonding strength to
root canal dentin: effect of the irrigation solution application
prior to post cementation. Braz Dent Sci. 2017;20(2):85-92.
http://dx.doi.org/10.14295/bds.2017.v20i2.1426.
18. Corazza PH, Domênico MBD, Facenda JC, Merlo EG, Borba M,
Ozcan M. Fiberglass versus cast metal posts: a practical review
based on mechanical properties. Braz Dent Sci. 2022;25(4):1-14.
http://dx.doi.org/10.4322/bds.2022.e3442.
19. De Andrade GS, Tribst JPM, Orozco EI, Augusto MG, Bottino
MA, Borges AL, et al. Influence of different post-endodontic
restorations on the fatigue survival and biomechanical
behavior of central incisors. Am J Dent. 2020;33(5):227-34.
PMid:33017523.
20. Fartes OAC, Resende LM, Cilli R, Carmo AMR, Baroudi K, Cortelli JR.
Retention of provisional intraradicular retainers using fiberglass
pins. J Int Soc Prev Community Dent. 2020;10(5):666-73. http://
dx.doi.org/10.4103/jispcd.JISPCD_298_20. PMid:33282778.
21. Lazari PC, Carvalho MA, Del Bel Cury AA, Magne P. Survival of
extensively damaged endodontically treated incisors restored
with different types of posts-and-core foundation restoration
material. J Prosthet Dent. 2018;119(5):769-76. http://dx.doi.
org/10.1016/j.prosdent.2017.05.012. PMid:28923548.
22. Fráter M, Lassila L, Braunitzer G, Vallittu PK, Garoushi S. Fracture
resistance and marginal gap formation of post-core restorations:
influence of different fiber-reinforced composites. Clin Oral
Investig. 2020;24(1):265-76. http://dx.doi.org/10.1007/s00784-
019-02902-3. PMid:31098711.
23. Sáry T, Garoushi S, Braunitzer G, Alleman D, Volom A, Fráter M.
Fracture behaviour of MOD restorations reinforced by various
fibrereinforced techniques: an in vitro study. J Mech Behav
Biomed Mater. 2019;98:348-56. http://dx.doi.org/10.1016/j.
jmbbm.2019.07.006. PMid:31302584.
24. Corrêa G, Brondani LP, Onofre RS, Bergoli CD. Restorative
strategies for weakened roots: systematic review and
meta-analysis of in vitro studies. Braz Dent Sci. 2019;22(1):124-34.
http://dx.doi.org/10.14295/bds.2019.v22i1.1672.
Kusai Baroudi
(Corresponding address)
RAK Medical and Health Sciences University, RAK College of Dental Sciences,
Ras al Khaimah, United Arab Emirates.
Email: d_kusai@yahoo.co.uk
Date submitted: 2023 Oct 26
Accept submission: 2023 Dec 14