Mously Hisham A, Naguib Ghada H, Abougazia Ahmed O, Almabadi Afaf A, Qutub Osama A, Hamed Mohamed T
Faculty of Dentistry, Department of Oral and Maxillofacial Prosthodontics, King Abdulaziz University, Jeddah, Saudi Arabia.
Faculty of Dentistry, Department of Restorative Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Oral Biology, Cairo University School of Dentistry, Cairo, Egypt.
Int Dent J. 2025 Feb;75(1):59-74. doi: 10.1016/j.identj.2024.07.1216. Epub 2024 Sep 20.
Restoring extensively damaged endodontically treated teeth presents a challenging task due to the state of biomechanical deterioration affecting long-term prognosis. Therefore, the study aims to assess and compare the biomechanical performance of endocrowns and post core-crown restorations in anterior endodontically treated teeth with severe coronal structure loss. Following PRISMA guidelines, a systematic search was conducted using PubMed, Scopus, Web of Science, and Google Scholar for articles published from January 2014 to March 2024. Two independent reviewers screened and selected studies based on the predefined inclusion and exclusion criteria. The included studies were analyzed using the QUIN tool for risk of bias assessment in in-vitro studies. Additionally, the biomechanical outcomes were collected for qualitative comparative analysis. Twelve studies were included in this systematic review. In most studies, Endocrowns demonstrated comparable fatigue resistance under load to failure to post core-crown restorations. Endocrowns without ferrule exhibited a higher rate of debonding but had significantly more repairable failures. Conversely, post core-crown restorations demonstrated higher fracture resistance with the presence of ferrule, but were associated with more catastrophic failure patterns. Additionally, endocrowns generated lower stress levels in both the restorative material and the luting material compared to post core-crown restorations. Among the tested materials, lithium disilicate ceramics provided the best biomechanical properties. Overall, the studies included provided sufficient information for most evaluation criteria of the QUIN risk of bias assessment tool. Endocrowns are a viable and conservative approach for restoring endodontically treated anterior teeth, offering comparable biomechanical performance to traditional post core-crown restorations and less catastrophic failures. The findings of this systematic review suggest that endocrown restorations, especially with lithium disilicate ceramics and proper ferrule design, can improve fracture resistance and longevity of rehabilitated teeth, enhancing patient outcomes for severely damaged anterior endodontically treated teeth.
由于生物力学退化状态影响长期预后，修复经根管治疗且广泛受损的牙齿是一项具有挑战性的任务。因此，本研究旨在评估和比较牙内冠与桩核冠修复体在根管治疗后严重牙冠结构丧失的前牙中的生物力学性能。按照PRISMA指南，使用PubMed、Scopus、Web of Science和谷歌学术对2014年1月至2024年3月发表的文章进行了系统检索。两名独立评审员根据预先定义的纳入和排除标准筛选并选择研究。使用QUIN工具对纳入的研究进行体外研究偏倚风险评估分析。此外，收集生物力学结果进行定性比较分析。本系统评价纳入了12项研究。在大多数研究中，牙内冠在载荷至失效时表现出与桩核冠修复体相当的抗疲劳性。没有箍的牙内冠脱粘率较高，但可修复的失败明显更多。相反，桩核冠修复体在有箍的情况下表现出更高的抗折性，但与更多灾难性的失败模式相关。此外，与桩核冠修复体相比，牙内冠在修复材料和粘结材料中产生的应力水平更低。在所测试的材料中，二硅酸锂陶瓷具有最佳的生物力学性能。总体而言，纳入的研究为QUIN偏倚风险评估工具的大多数评估标准提供了充分的信息。牙内冠是修复根管治疗后的前牙的一种可行且保守的方法，其生物力学性能与传统的桩核冠修复体相当，且灾难性失败较少。本系统评价的结果表明，牙内冠修复，特别是使用二硅酸锂陶瓷和适当的箍设计，可以提高修复牙齿的抗折性和寿命，改善根管治疗后严重受损前牙患者的治疗效果。
