Can fiber placement influence the fracture resistance of endodontically treated teeth with indirect partial ceramic restorations? A systematic review and meta-analysis

Abstract

Statement of problem: Restoring endodontically treated teeth with indirect partial ceramic restorations poses biomechanical challenges associated with the compromised tooth structure, and the potential role of fiber reinforcement in improving fracture resistance remains unclear.

Purpose: The purpose of this systematic review and meta-analysis was to determine whether reinforcing the endodontically treated tooth structures with fiber ribbons or short fiber-reinforced resin composites (SFRCs) increases the fracture resistance of indirect partial ceramic restorations.

Material and methods: A database search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to November 2024. Eligible in vitro studies assessed the fracture resistance of indirect partial ceramic restorations in endodontically treated premolars or molars by comparing fiber-reinforced (FR) and nonfiber-reinforced (NFR) teeth. Exclusions included studies on direct resin composites, foundation restorations, indirect resin composites, nonrestorative specimens, or nonendodontically treated teeth. Data were analyzed using a random-effects model, with subgroup analyses conducted to identify potential sources of heterogeneity (α=.05). Sensitivity analysis and the Egger regression test were used to evaluate reliability and publication bias. Methodological quality was assessed using the QUIN Tool.

Results: Of 3299 records, 7 articles were included. Three meta-analyses were conducted, including an overall analysis of SFRCs and fiber ribbons, along with separate analyses for each. The overall analysis revealed no significant differences between FR and NFR groups (SMD: 0.21, 95% CI: [-0.51, 0.92], I²=88.39%, P<.001). The SFRC analysis also showed no significant differences (SMD: 0.06, 95% CI: [-0.98, 1.10], P=.905), with high heterogeneity (I²=91.92%, P<.001). The fiber ribbon analysis revealed significant differences (SMD: 0.63, 95% CI: [0.16, 1.10], P=.009), with low heterogeneity (I²=22.83%, P=.248).

Conclusions: Fiber ribbons showed promise for enhancing the fracture resistance of indirect partial ceramic restorations in endodontically treated posterior teeth.