Archer Madeline
Edinburgh Dental Institute Paediatric Department 39x Lauriston Building, Edinburgh, UK.
Evid Based Dent. 2025 Mar;26(1):10-11. doi: 10.1038/s41432-025-01126-7. Epub 2025 Mar 11.
Fehrenbach J, de Soares J L S, do Nascimento Foly J C S, Miotti L L, Münchow E A Mechanical performance of endocrown restorations in anterior teeth: A systematic review and network meta-analysis. Dent Mater 2025; https://doi.org/10.1016/j.dental.2024.10.012 .
A systematic review and network meta-analysis (NMA) of anterior endocrown mechanical performance compared to conventional crowns on endodontically treated teeth (ETT). An online search of major databases was conducted and relevant studies were selected. Data was extracted and meta-analyses performed comparing mechanical outcomes of anterior endocrowns to other crown systems. Endocrowns on the anterior dentition can be considered if mechanical fracture is a concern, however more research needs to be done before definitive case selection.
Two independent reviewers searched six electronic databases (PubMed, Scopus, Web of Science, Embase, SciELO and LILACS) using compounded terms like ETT and anterior and endocrown along with their variates. Manual searches were also done from the reference list of chosen studies. Following the search titles were put through Rayyan, an AI-powered systematic reviewer to remove duplicates. The reviewers then screened 25 random titles and abstracts independently and repeated this with a third reviewer.
Inclusion criteria were studies examining anterior ETT and endocrown compared with a different restoration. Exclusion criteria were non-experimental studies, theses, languages other than English Spanish or Portuguese and studies not evaluating mechanical performance. From this 24 studies were read in full and 11 were selected for the review. Bias risk assessment was done by two reviewers using the RoBDEMAT tool for in vitro studies and ROBFEAD tool for Finite Element Analysis (FEA) studies. The studies are scored as low, med, or high risk according to each tool's domains.
Two reviewers extracted the data onto Microsoft Excel including authors name and year of publication, tooth type, endocrown depth, distance between the CEJ and finishing line,surface treatment, luting agent, thermocycling method, etc. Data synthesis and analysis was performed by MetaInsight V4 4.0.0 and two independent NMA's were made. The first NMA used load-to-fracture data and a mean difference outcome while the second used irreparable fracture data and a risk ratio outcome. Both used a 95% credible interval(Crl). Comparisons were evaluated using Surface Under the Cumulative ranking Curve (SUCRA), where a value closer to 100% indicates greater resistance to fracture.
Eight studies used in vitro experiments, most of them investigating load-to-fracture and failure mode of fractured restorations and one study the pull-out bond strength. The remaining three studies used FEA models and examined von mises criterion by quantifying a material's fracture under stress. The first NMA considered load-to-fracture data and examined five studies. The probabilistic analysis showed teeth restored with a Glass Fibre Post (GFP) and composite crown performed best (SUCRA = 95.23%), with higher load-to-fracture values (MD 165.0, 95% CRL 28.3, 301.0) than the Composite endocrown group (MD 78.1 95% Crl 6.21, 150.0). Lowest ranking was the GFP plus ceramic crown group, with ceramic endocrowns and ceramic crowns without post in between. The second NMA analysed irreparable fracture data from five studies. The composite endocrown group showed a lower catastrophic fracture risk (RR 0.413, 95% Crl 0.152, 0.859) compared to the GFP ceramic crown group (RR 1.36, 95% Crl 1.09, 1.80). Probabilistic analysis shows composite endocrowns with the lowest risk of irreparable fracture (SUCRA = 96.84%), followed by ceramic crown with no core, ceramic endocrowns and GFP crown groups with the highest risk.
Endocrowns may be a viable choice for endodontically treated anterior teeth because they perform similarly to other restorative systems under mechanical load in lab and model scenarios. GRADE rating is low due to high risk of bias.
费伦巴赫J、德索阿雷斯J L S、多纳西门托·福利J C S、米奥蒂L L、明乔E A 前牙内冠修复体的力学性能：系统评价与网状Meta分析。《牙科材料》2025年；https://doi.org/10.1016/j.dental.2024.10.012 。
对经根管治疗的牙齿（ETT）上的前牙内冠与传统冠的力学性能进行系统评价和网状Meta分析（NMA）。对主要数据库进行在线检索并选择相关研究。提取数据并进行Meta分析，比较前牙内冠与其他冠系统的力学结果。如果担心机械性折断，前牙牙列上的内冠可予以考虑，然而在确定最终病例选择之前还需要进行更多研究。
两名独立的评审人员使用如ETT、前牙和内冠及其变体等复合术语检索了六个电子数据库（PubMed、Scopus、科学网、Embase、SciELO和LILACS）。还从所选研究的参考文献列表中进行了手工检索。检索后的标题通过Rayyan（一种人工智能驱动的系统评审工具）去除重复项。然后，评审人员独立筛选25个随机标题和摘要，并与第三位评审人员重复此操作。
纳入标准为研究将前牙ETT和内冠与不同修复体进行比较。排除标准为非实验性研究、论文、非英语、西班牙语或葡萄牙语的语言以及未评估力学性能的研究。从中全文阅读了24项研究，并选择了11项进行综述。两名评审人员使用RoBDEMAT工具对体外研究进行偏倚风险评估，使用ROBFEAD工具对有限元分析（FEA）研究进行评估。根据每个工具的领域，将研究评为低、中或高风险。
两名评审人员将数据提取到Microsoft Excel中，包括作者姓名和发表年份、牙齿类型、内冠深度、牙骨质牙釉质界（CEJ）与修整线之间的距离、表面处理、粘结剂、热循环方法等。数据综合与分析由MetaInsight V4 4.0.0进行，并进行了两项独立的NMA。第一个NMA使用断裂载荷数据和平均差值结果，而第二个使用不可修复性折断数据和风险比结果。两者均使用95%可信区间（Crl）。使用累积排序曲线下面积（SUCRA）评估比较结果，其中更接近100%的值表示对折断的抵抗力更强。
八项研究采用体外实验，其中大多数研究了折断修复体的断裂载荷和失效模式，一项研究了拔出粘结强度。其余三项研究使用FEA模型，并通过量化材料在应力下的断裂来检查冯·米塞斯准则。第一个NMA考虑了断裂载荷数据并审查了五项研究。概率分析表明，用玻璃纤维桩（GFP）和复合冠修复的牙齿表现最佳（SUCRA = 95.23%），其断裂载荷值（MD 165.0，95% CRL 28.3，301.0）高于复合内冠组（MD 78.1，95% Crl 六21，150.0）。排名最低的是GFP加陶瓷冠组，陶瓷内冠和无桩陶瓷冠介于两者之间。第二个NMA分析了五项研究的不可修复性折断数据。与GFP陶瓷冠组（RR 1.36，95% Crl 1.09，1.80）相比，复合内冠组显示出较低的灾难性折断风险（RR 0.413，95% Crl 0.152，0.859）。概率分析表明，复合内冠的不可修复性折断风险最低（SUCRA = 96.84%），其次是无核陶瓷冠、陶瓷内冠和GFP冠组，风险最高。
内冠可能是经根管治疗的前牙的一种可行选择，因为在实验室和模型场景下，它们在机械载荷下的表现与其他修复系统相似。由于偏倚风险高，GRADE评级为低。
