Do Metal Post–retained Restorations Result in More Root Fractures than Fiber Post–retained Restorations? A Systematic Review and Meta-analysis

Published:November 11, 2014DOI:


      • Fiber and metal posts present similar survival rates in clinical studies.
      • The incidence of root fractures observed among metal and fiber posts was similar.
      • In clinical trials, metal posts showed a higher incidence of root fractures.
      • Cast posts result in less root fracture than metal prefabricated metal posts.
      • The incidence of root fracture was lower for glass fiber than carbon fiber posts.



      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.


      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.


      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.


      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.

      Key Words

      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 Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cheung W.
        A review of the management of endodontically treated teeth. Post, core and the final restoration.
        J Am Dent Assoc. 2005; 136: 611-619
        • Bateman G.
        • Ricketts D.N.J.
        • Saunders W.P.
        Fibre-based post systems: a review.
        Br Dent J. 2003; 195 (discussion 37): 43-48
        • Zhou L.
        • Wang Q.
        Comparison of fracture resistance between cast posts and fiber posts: a meta-analysis of literature.
        J Endod. 2013; 39: 11-15
        • Santos A.F.
        • Meira J.B.
        • Tanaka C.B.
        • et al.
        Can fiber posts increase root stresses and reduce fracture?.
        J Dent Res. 2010; 89: 587-591
        • Zicari F.
        • Van Meerbeek B.
        • Debels E.
        • et al.
        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: 363-372
        • Ferrari M.
        • Vichi A.
        • Fadda G.M.
        • et al.
        A randomized controlled trial of endodontically treated and restored premolars.
        J Dent Res. 2012; 91: 72S-78S
        • Higgins J.P.T.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Wells G.A.
        • Shea B.
        • O'Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses.
        Department of Epidemiology and Community Medicine, University of Ottawa, Canada2000
        • Bhaumik D.K.
        • Amatya A.
        • Normand S.-L.
        • et al.
        Meta-analysis of rare binary adverse event data.
        J Am Stat Assoc. 2012; 107: 555-567
        • Cochran W.G.
        The combination of estimates from different experiments.
        Biometrics. 1954; 10: 101
        • Higgins J.P.T.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.P.T.
        • Rothstein H.R.
        A basic introduction to fixed-effect and random-effects models for meta-analysis.
        Res Synth Methods. 2010; 1: 97-111
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Sterne J.A.C.
        • Egger M.
        • Smith G.D.
        Investigating and dealing with publication and other biases in meta-analysis.
        BMJ. 2001; 323: 101-105
        • Creugers N.H.J.
        • Kreulen C.M.
        • Fokkinga W.A.
        A 5-year prospective clinical study on core restorations without covering crowns.
        Int J Prosthodont. 2005; 18: 40-41
        • Ellner S.
        • Bergendal T.
        • Bergman B.
        Four post-and-core combinations as abutments for fixed single crowns: a prospective up to 10-year study.
        Int J Prosthodont. 2003; 16: 249-254
        • Ferrari M.
        • Cagidiaco M.C.
        • Goracci C.
        • et al.
        Long-term retrospective study of the clinical performance of fiber posts.
        Am J Dent. 2007; 20: 287-291
        • Gómez-Polo M.
        • Llidó B.
        • Rivero A.
        • et al.
        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: 916-920
        • Hikasa T.
        • Matsuka Y.
        • Mine A.
        • et al.
        A 15-year clinical comparative study of the cumulative survival rate of cast metal core and resin core restorations luted with adhesive resin cement.
        Int J Prosthodont. 2010; 23: 397-405
        • Jung R.E.
        • Kalkstein O.
        • Sailer I.
        • et al.
        A comparison of composite post buildups and cast gold post-and-core buildups for the restoration of nonvital teeth after 5 to 10 years.
        Int J Prosthodont. 2007; 20: 63-69
        • King P.A.
        • Setchell D.J.
        • Rees J.S.
        Clinical evaluation of a carbon fibre reinforced carbon endodontic post.
        J Oral Rehabil. 2003; 30: 785-789
        • Mannocci F.
        • Qualtrough A.J.E.
        • Worthington H.V.
        • et al.
        Randomized clinical comparison of endodontically treated teeth restored with amalgam or with fiber posts and resin composite: five-year results.
        Oper Dent. 2005; 30: 9-15
        • 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: 432-435
        • Segerström S.
        • Astbäck J.
        • Ekstrand K.D.
        A retrospective long term study of teeth restored with prefabricated carbon fiber reinforced epoxy resin posts.
        Swed Dent J. 2006; 30: 1-8
        • Signore A.
        • Benedicenti S.
        • Kaitsas V.
        • et al.
        Long-term survival of endodontically treated, maxillary anterior teeth restored with either tapered or parallel-sided glass-fiber posts and full-ceramic crown coverage.
        J Dent. 2009; 37: 115-121
        • 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: 1557-1563
        • Weine F.S.
        • Wax A.H.
        • Wenckus C.S.
        Retrospective study of tapered, smooth post systems in place for 10 years or more.
        J Endod. 1991; 17: 293-297
        • Dwyer T.
        • Couper D.
        • Walter S.D.
        Sources of heterogeneity in the meta-analysis of observational studies: the example of SIDS and sleeping position.
        J Clin Epidemiol. 2001; 54: 440-447
        • Hickel R.
        • Roulet J.-F.
        • Bayne S.
        • et al.
        Recommendations for conducting controlled clinical studies of dental restorative materials.
        Clin Oral Investig. 2007; 11: 5-33