Guided versus non-guided fiber post removal: A systematic review and meta-analysis of the accuracy, efficiency, and dentin preservation of static navigation techniques in the removal of fiber posts.

STATEMENT OF PROBLEM

Fiber posts have been frequently used to restore endodontically treated teeth because of their favorable esthetic and mechanical properties. However, their removal, especially when fractured or debonded, poses a considerable clinical challenge. Conventional techniques for fiber post removal can be time consuming, risk excessive dentin loss, and lead to unpredictable deviations from the original canal path. With the emergence of guided technologies, their potential advantages over non-guided methods in terms of accuracy, dentin preservation, and efficiency require clarification.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate whether guided techniques improve the accuracy of fiber post removal from endodontically treated teeth compared with non-guided approaches by focusing on time spent, dentin loss, and deviation.

MATERIAL AND METHODS

A systematic search limited to publications up to October 2024 was conducted in 5 databases (PubMed, Scopus, Scopus Secondary, Embase, and Web of Science). Specific keywords included variations of "fiber post" and "guided." After removing duplicates and applying inclusion criteria (studies testing guided fiber post removal with reported time, dentin loss, and/or deviation), 6 experimental studies remained for quantitative synthesis. Two independent reviewers evaluated eligibility, and a third resolved disagreements. Data extracted included sample sizes (ranging from 8 to 60 teeth per study), operator experience, measurement methods (digital imaging, cone beam computed tomography (CBCT), 3-dimensionally (3D) printed guides, and microscopic assessment), and outcomes. To assess the risk of bias, the revised JBI critical appraisal tool was used. Meta-analyses were performed using random-effects models, computing pooled means, standard mean differences (SMD), and 95% confidence intervals (CI). Heterogeneity was evaluated with the I² statistic (α=.05).

RESULTS

From the 5 included studies, guided techniques showed a pooled mean time spent of 3.47 minutes (95% CI, 1.70 to 5.25) and a deviation of 2.63 degrees (95% CI, 2.37 to 2.89). Dentin loss in the guided groups (3.83 mm³; 95% CI, -0.53 to 8.19) was statistically similar (P>.05). Comparisons between guided and non-guided groups revealed an SMD of -0.95 (95% CI, -3.19 to 1.29) for time and -2.06 (95% CI, -5.01 to 0.89) for dentin loss, with no significant differences noted (P>.05).

CONCLUSIONS

Guided fiber post removal techniques demonstrated statistically significant improvements in accuracy, specifically in angular and linear deviations. However, differences in dentin loss and procedure time between guided and non-guided approaches were not statistically significant. Additional standardized, large-scale studies are necessary to comprehensively evaluate the clinical benefits of guided techniques.