Selection criteria: The authors searched MEDLINE, EMBASE, CENTRAL, and Scopus electronic databases through 2004 for eligible articles. The authors also searched International Association for Dental Research conference proceedings and abstracts from 1996-2004 and contacted manufacturers and other known experts to identify unpublished studies. Studies had to be randomized or quasi-randomized clinical trials (RCT) evaluating failures of endodontically-treated permanent teeth with different post types. This systematic review included one clinical study related to answering the primary objective, and this study involved 200 patients, 100 receiving a fiber post and 100 receiving a cast metal post. A second clinical study was included as related to a secondary objective and that study involved 117 patients, with 60 receiving a composite resin restoration as the definitive treatment after placement of a fiber post and 57 receiving a complete coverage metal ceramic crown as the definitive treatment after a fiber post had been placed.
Key study factor: The primary treatment of interest was the type of post used, metal versus non-metal. A secondary interest was the prosthetic status of the tooth, carbon fiber post followed by a composite resin restoration versus a carbon fiber post followed by a metal ceramic crown.
Main outcome measure: The main measure used to evaluate treatment effectiveness for the primary objective (metal versus non-metal post) and the secondary objective (composite resin definitive restoration versus metal ceramic crown) was post failure.
Main results: Regarding the study addressing the primary objective, the fiber post resulted in fewer failures (0/97) than the conventional cast post and core system (9/98) after 4 years of clinical service. The risk ratio (RR) = 0.05, and there was a 95% confidence interval (CI) of 0.00 to 0.90. This study was judged to be at high risk of bias. Root fracture was the only failure encountered in the cast post and core group.
Conclusions: The results suggest fiber posts may be more successful than cast metal posts, but there were not enough RCTs to warrant a definitive recommendation.