What about anterior endocrowns?
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.
Archer M
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Mechanical performance of endocrown restorations in anterior teeth: A systematic review and network meta-analysis.
To conduct a systematic review and network meta-analysis (NMA) to answer whether endocrown restorations have similar mechanical behavior than other traditional core-crown systems with or without intracanal posts for the rehabilitation of anterior endodontically treated teeth.
The review followed the PRISMA Extension Statement for NMA. Studies were identified by a systematic search to select reports on endocrown restorations in anterior teeth. A search was performed in PubMed (MEDLINE), Scopus, Web of Science, Embase, SciELO, and LILACS databases. Articles evaluating mechanical performance through in vitro and finite element analysis (FEA) studies were selected and the risk of bias was assessed using the RoBDEMAT and ROBFEAD tools, respectively. The data were analyzed qualitatively and quantitatively through NMA using the MetaInsight tool.
Eleven articles were included (eight in vitro and three with FEA design). Six in vitro studies were evaluated using NMA. Composite resin endocrowns showed greater load-to-fracture and lower occurrence of catastrophic failures than traditional restorations. Combining glass fiber post with composite restoration also showed good strength behavior. Regarding FEA studies, two out of three studies showed a more homogeneous distribution of stress for the endocrown group.
Endocrowns performed similarly to or better than conventional restorative strategies, with composite resin being the most recommended material of choice. The rehabilitation of endodontically treated anterior teeth with extensive coronal destruction is typically challenging for the dentist, and there is still no consensus in the literature that provides conclusive answers for choosing the appropriate material and restorative strategy. Exploring new techniques and materials that make this procedure easier for the dentist and guarantee good results is paramount.
Fehrenbach J
，de Soares JLS
，do Nascimento Foly JCS
，Miotti LL
，Münchow EA
... -
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Comparison of clinical efficacy of CAD CAM Endocrowns made of feldspathic ceramic, zirconia lithium silicate, and lithium disilicate: A two-year mixed cohort study.
Endocrowns can be fabricated from various materials as a treatment option for endodontically treated teeth. This mixed cohort study aimed to demonstrate the clinical efficacy of Endocrowns made of feldspathic, zirconia lithium silicate, and lithium disilicate ceramics using a chairside CAD/CAM system.
The present study compared the clinical outcomes of 141 Endocrown restorations in posterior teeth of 85 patients in a two-year follow-up. The efficacy of restorations was evaluated in three aspects: esthetics, biological response, and function, with the aid of the FDI guideline, and presented as descriptive analyses. Additionally, the data were analyzed using Chi-square and Spearman correlation tests. The significance level was set at p = 0.05.
The study findings revealed that the type of restorations (feldspathic ceramic, zirconia lithium silicate, and lithium disilicate) (p > 0.05) and underlying teeth (molars and premolars) (p > 0.05) play no part in restorations' failure. Caries' recurrence is primarily responsible for the failure of the endocrowns. Secondary caries and radiolucency were observed in four teeth (2.83 %). The clinical efficacy of 126 restorations (89.36 %) fell into the category of "clinically excellent" and "clinically good." Ten restorations (7.09 %) were classified as "clinically sufficient/satisfactory," and only five restorations (3.54 %) needed replacement due to having "clinically unsatisfactory" and "clinically poor" quality.
Endocrowns showed a high success rate and durability in the short term, therefore can be considered a safe choice for restoring endodontically treated teeth. It is worth noting that caries were the most common reason for the failure of the restorations.
Endocrowns made of different ceramics have been proven reliable restorations for endodontically treated molars and premolars.
Jalali S
，Asgari N
，Pirooz P
，Younespour S
，Atri F
... -
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ResearchGate
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