Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, 152006005, India.
Department of Cariology, Saveetha Dental College & Hospitals, SIMATS, Chennai, India.
BMC Oral Health. 2023 Aug 13;23(1):566. doi: 10.1186/s12903-023-03217-2.
Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance.
The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites.
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed.
The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth.
According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.
大的窝洞设计和入口窝洞会损害根管治疗后的牙齿抗折能力。由于根管治疗后牙齿的强度会显著降低，咀嚼、咬和某些功能紊乱等功能会导致牙齿受到咬合负荷，使根管治疗后的牙齿容易发生折裂。因此，根管治疗后，给予足够和适当的修复材料以避免牙齿折裂是至关重要的。因此，这种修复材料的选择应该取决于抗折能力的特性。
本研究的目的是对体外研究中检查纤维增强复合材料修复的根管治疗后后牙抗折能力的可用数据进行系统评价和批判性分析。
采用首选报告项目系统评价和荟萃分析（PRISMA）声明来指导本系统评价的报告。使用 MEDLINE（通过 PubMed）、Scopus、ScienceDirect、Google Scholar 和 LILACS 进行全面的文献检索。还对文章的参考文献进行了手动搜索。电子系统搜索共提供了来自数据库的 796 项研究。数据库提供了来自电子系统搜索的总共 796 项研究。两名审查员根据纳入/排除标准和提取数据仔细检查了论文的资格。对研究进行了潜在偏倚风险评估。根据改良 JBI & CRIS（体外研究报告检查表）指南以及方法和治疗目标，我们专门制定了 13 个参数来评估偏倚风险。共有 18 项研究符合纳入标准并纳入定性分析。由于纳入研究的高度异质性，无法进行荟萃分析。
大多数纳入的研究都存在中度或高度偏倚风险。在大多数研究中，与传统混合复合材料相比，纤维增强复合材料显示出增加了根管治疗后牙齿的抗折能力。另一方面，对于大块填充复合材料的证据有限。此外，对于纤维增强复合材料用于根管治疗后牙齿的核构建的嵌体和纤维桩的抗折能力，发现了中度证据。对于根管治疗后牙齿的纤维增强复合材料的根管冠的抗折能力，没有证据。
根据研究，使用纤维增强复合材料代替传统混合复合材料可以提高根管治疗后牙齿的抗折能力。然而，所考虑的研究存在高度偏倚风险。基于根管治疗后牙齿不同核心修复体之间的比较，无法对一种材料相对于另一种材料的优势做出判断。
