Intraradicular posts are useful adjuncts in the restoration of endodontically treated teeth. These systems have undergone a significant evolution in recent years, and fiber-reinforced systems have started to be incorporated into routine clinical care more frequently. Despite the high number of laboratory studies pertaining to the characteristics of fiber posts, clinical studies evaluating their general success rates are rather limited. Since clinical investigations are reliable means to achieve information about the general behavior pattern of materials or techniques, assessment of this data will be beneficial to have a better understanding of fiber-reinforced intraradicular post systems. The purpose of this paper was to make a summary of clinical studies regarding various fiber posts. A PubMed search was conducted and articles dating back to 1990 were retrieved. The paper provides an overview of clinical studies on fiber posts specifically in the last decade as well as commentary analysis.
It is generally the common opinion of dental authorities that endodontically treated teeth are more prone to fracture due to a variety of factors such as extensive tissue loss, loss of moisture content, and flexibility as well as decrease in resistance due to endodontic access preparations [
Usage of intracanal posts is a commonly practiced procedure specifically for challenging cases indicated above. This application is especially preferred for the restoration of endodontically treated teeth where extensive loss of hard tissue necessitates additional reinforcement of the remaining structure apart from the crown itself.
The most common type of posts used in dentistry has been cast post and cores in the last decade which generally includes an additional laboratory stage where a custom post is prepared according to the impression taken from the prepared post space. In case the practitioner prefers a faster application without an impression-taking stage, prefabricated metallic posts have also been launched to the market, with a wide range of structural designs, serving the requirements of different clinical cases. Screw posts are also available; however, it has been indicated that these should be inserted with caution as they might result in undesirable complications such as vertical root fractures [
Although cast or prefabricated metallic posts have been widely used for a long period, some disadvantages and drawbacks have also been determined associated with these systems among which loss of retention, root fractures, corrosion, necessity of removal of extensive root structure, and stress concentration can be given as examples [
Consequently, the complications related to these systems have been observed as less catastrophic, which generally includes relatively more reparable problems such as debonding. Additionally, the less invasive and more conservative space preparation required by these systems has been a significant advantage [
Although prefabricated fiber posts have been assessed in terms of their mechanical and physical properties through various
This review article attempted to collect and summarize information accumulated so far pertaining to fiber post systems used in clinical circumstances and critically analyze fiber posts through data gathered by long-term clinical examination. A PubMED search was conducted by inserting keywords “fiber post,” “clinical study,” and “dentistry.” Twenty-four clinical articles were retrieved. Prospective and retrospective long-term clinical studies were among the inclusion criteria whereas review articles, case reports, or studies including the followup of a limited number of cases were excluded based on the assumption that data accumulated through long-term clinical studies are essential for a general practitioner when making clinical decisions [
The table summarizes general information on clinical studies performed on fiber posts between 1998 and 2012. The term “success” stands for those teeth without any indication of extraction as well as complications such as debonding, post fracture during the conclusion of the serving period.
Year | Author(s) | Study design | Type of posts assessed | Follow-up period | Success rate (percentage) | |
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1 | 1998 |
Fredriksson et al. [ |
Retrospective | Composipost | 2-3 years | 98 |
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2 | 2000 | Glazer [ |
Prospective | Composipost | 6.7–45.4 months | 89.6 |
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3 | 2000 | Ferrari et al. [ |
Prospective | Composipost, conventional cast post-core | 4 years | 95 |
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4 | 2000 | Ferrari et al. [ |
Prospective | Composipost, Aestheti posts, Aestheti-Plus posts | 1–6 years | 96.8 |
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5 | 2002 | Mannocci et al. [ |
Prospective | Composipost + full cast coverage |
1, 2, and 3 years | Composiposts + full cast coverage: |
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6 | 2003 | King et al. [ |
Prospective | Carbon fiber post, metallic prefabricated posts | 24, 29, 56, and 87 months | Carbon fiber post: 71 |
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7 | 2003 |
Hedlund et al. [ |
Retrospective | Composipost, Endopost | 2, 3 years | 97 |
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8 | 2003 | Monticelli et al. [ |
Prospective | Aestheti Plus (quartz fiber) posts, DT Light posts and FRC Postec posts | 2 years | 93.8 |
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9 | 2003 | Malferrari et al. [ |
Prospective | Aestheti-Plus posts (quartz fiber) | 30 months | 98.3 |
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10 | 2005 | Naumann et al. [ |
Prospective | FiberKor posts (3 sizes) (parallel sided and tapered glass fiber) | 12 months and 24 months | 12 months: 96.2 |
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11 | 2005 | Naumann et al. [ |
Prospective | FiberKor posts (parallel sided) |
5-6 months (ave: 3.9) | 93.3 |
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12 | 2005 | Grandini et al. [ |
Prospective | DT Light posts + direct resin composite | 6, 12, 24, and 30 months | No cumulative data given |
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13 | 2007 | Schmitter et al. [ |
Prospective | Glass fiber posts, screw posts | 1 year | 93.5 |
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14 | 2007 | Cagidiaco et al. [ |
Prospective | DT Light posts | 23–25 months | Post debondings: 4.3 |
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15 | 2007 | Naumann et al. [ |
Prospective | Titanium posts, fiber reinforced posts | 2-3 years | 100 |
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16 | 2007 | Piovesan et al. [ |
Prospective | Polyethylene fiber posts | 97 months | 95 |
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17 | 2008 | Preethi and Kala [ |
Prospective | Carbon fiber posts, glass fiber posts, cast posts | 1 year | 100 |
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18 | 2008 |
Mehta and Millar [ |
Prospective | Fibre-White Parapost cemented either by Calibra or Panavia. | 38–54 months | Calibra: 64.1 |
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19 | 2009 | Signore et al. [ |
Retrospective | FibreKor fiber posts (parallel sided or tapered) | 5.3 years | 98.5 |
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20 | 2011 | Ghavamnasiri et al. [ |
Retrospective | RTD posts (quartz fiber), extensive composite resin | 1–6 years | 48.8 |
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21 | 2011 | Schmitter et al. [ |
Prospective | ER dentin posts (glass fiber) and titanium screw posts | 5 years | 71.8 |
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22 | 2011 | Zicari et al. [ |
Prospective | Prefabricated posts |
7–37 months | Prefabricated: 91.7 |
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23 | 2012 | Naumann et al. [ |
Prospective | Glass fiber posts | 120 months | 63 |
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24 | 2012 | Sterzenbach et al. [ |
Prospective | Glass fiber posts, titanium posts | 84 months | Glass fiber posts: 90.2 |
The history of nonmetallic posts dates back to 1990 with the introduction of Composipost, based on the carbon fiber reinforcement principle [
Although the system was launched in 1990, it was not until 1998 that a long-term study was undertaken to assess its clinical performance. Fredriksson et al. [
Another study evaluating Composiposts was by Glazer [
Ferrari et al. [
Composipost has drawn attention not only as the survival period of teeth where it is used but by also the influence of the overlying restoration type on its survival rate. An example to such an assessment was the study by Mannocci et al. [
As years progressed, attempts were made to reinforce the existing carbon fiber post systems. CFRC, a reinforced version of carbon fiber, has also been studied clinically and compared with conventional cast posts. The uniqueness of this post system was the alignment of the principal fibers at an angle to the principle axis of the composite, a high elastic modulus and possibility of transverse strength. King et al. [
Hedlund et al. [
Clinical efficacy of esthetic fiber posts other than carbon fiber started to be clinically evaluated in the year 2003. Monticelli et al. [
The authors criticized previous retrospective study designs indicating that the variables used in a prospective study design are controlled at the stage of the case selection and experimental groups can be made homogeneous in all but the variable under study. They also stated that such a study model allows the limitation of confounding factors and delivers more reliable and valuable information. Thus, the variables under study, that is, the different materials used for the restoration, became the factors most crucially responsible for the variability in the clinical performance of the teeth over time. This comment of the authors deserves merit as the types of teeth, cementation techniques, and the operator performing the procedures were also standardized, thus allowing only the materials tested to be evaluated from a clinical perspective.
In line with the results of the previous investigations, failure modes were not catastrophic and they were rather salvageable. The authors also reported that as no difference was noted among the 3 translucent post systems tested, the selection of the adhesive-cement combination basically becomes a matter of personal preference of the clinician, based on experience and habits.
In a prospective study evaluating the clinical performance and acceptability of quartz fiber-reinforced epoxy posts used in endodontically treated teeth over a 30-month period, 180 endodontically treated teeth belonging to 132 patients were restored using Aestheti-Plus quartz-fiber posts. The percentage of failures was reported as only 1.7 over a 30-month period and replacement was possible in all failed cases. In general, these posts systems yielded favorable clinical results with a success rate of 98.3% [
Naumann et al. [
Fiber posts (DT Light) were assessed in terms of clinical performance when used with direct resin composites and this combination was proposed as a treatment option that conserves remaining tooth structure in the short term and results in good patient compliance [
Schmitter et al. [
In another study evaluating the 2-year outcome of restorative procedures involving the placement of fiber posts in endodontically treated teeth concluded that the major failure types associated with this treatment type were post debonding reported as 4.3% and endodontic failures reported as 3.0% [
Naumann et al. [
In later years, it is observed that more focus is given on prospective studies with established baseline criteria. A long-term prospective study on 69 patients evaluated Polyethylene fiber-reinforced posts and cores used in endodontically treated teeth over a 97-month period after which high survival rates (95%) were obtained. Moreover, tooth location or type of restorative material had no impact on the overall survival rates [
In a short-term study in which cast post and core, carbon fiber reinforced post, and glass fiber reinforced post with composite core restorations were analyzed for a period of 12 months, fiber reinforced post with composite core when used in single rooted upper anterior teeth were found to be associated with a higher success rate in restoration of endodontically treated teeth [
Mehta and Millar [
Signore et al. [
Another retrospective study was by Ghavamnasiri et al. [
When using self-adhesive luted prefabricated posts in severely destroyed abutment teeth with 2 or less cavity walls and a 2-mm ferrule, postendodontic restorations achieved high long-term survival rates irrespective of the post material used (i.e., glass fiber versus titanium).
Glass fiber and metal screw posts were prospectively analyzed over a period of 5 years after which the survival rate of glass fibers was found to be 71.8%. The degree of coronal tooth structure and the post system used posed important factors in terms of risks. On the other hand, some negative statements were also brought in terms of glass fibers over an extended period [
A long-term study that evaluated 10-year survival of glass-fiber supported prosthodontic restorations revealed relatively high annual failure rate of glass reinforced fiber posts [
A recent pilot study [
This review article attempted to provide an overview of publications in the last decade regarding fiber reinforced posts that draw the attention of a growing number of practitioners recently. Multiple causes of failure need to be analyzed when examining the failure patterns associated with intraradicular post systems such as secondary caries, loss of retention and debonding of the post and crown, root fractures, and distortion of posts as well as post fractures. On the other hand, as observed from this review, clinical investigations performed so far are difficult to compare due to the inconsistencies between sample selections, and established baseline criteria are necessary such as assessment of endodontic treatment, degree of coronal tissue loss, and presence of parafunctional habits. Furthermore; incorporation of a ferrule is very difficult to standardize due to the discrepancies between the types of hard tissue loss associated with each individual case. From this perspective, suggestions can be brought regarding the necessity of standardizing study designs for future trials to obtain more reliable data. Nevertheless, some general statements can be made based on the accumulated data so far such as the favorable and high survival rates associated with fiber post systems. It is also noteworthy to mention that, despite the high number of