Do CAD-CAM fibre posts exhibit higher bond strength and fracture resistance than other types of posts? systematic review with network meta-analysis of in-vitro studies.

Introduction: Pre-fabricated fibre posts facilitate post-endodontic restoration of endodontically treated teeth with insufficient coronal tooth structure. Recent advancements in digital dentistry have led to the introduction of custom-made fibre posts fabricated with computer-aided design-computer-aided manufactured (CAD-CAM) technology. However, evidence on the comparative performance of the different post-types is lacking. This systematic review with network meta-analysis aimed to analyse the current evidence on in-vitro studies comparing bond strength, catastrophic failures, fracture resistance, and cement film thickness between CAD-CAM fibre posts and other post types, including pre-fabricated fibre and custom-made cast-metal posts.

Materials and methods: A systematic search was conducted in PubMed, Scopus, and the Cochrane Central Register of Controlled Studies for in-vitro studies from inception until December 2023 (PROSPERO: CRD42024501614). Network meta-analysis and pairwise meta-analysis were performed. The ranking was performed using the surface area under the cumulative ranking (SUCRA) guidelines.

Results: Seven hundred forty-one articles were identified, of which 80 duplicates were removed, and 585 were excluded by screening the titles and abstracts. A total of 76 articles were assessed by full-text reading, and 16 were included in the quantitative synthesis. CAD-CAM fibre posts (SMD = 1.09 [95% CI: 0.01, 2.17]) P = 0.04 demonstrated higher bond strength when compared to pre-fabricated posts. CAD-CAM fibre posts (RR = 0.39 [95% CI: 0.23, 0.69]) P < 0.05 demonstrated a lower risk for catastrophic failures when compared to pre-fabricated fibre posts.

Conclusions: In-vitro studies demonstrated that CAD-CAM fibre posts demonstrated higher bond strength, lower catastrophic failure rates, and similar fracture resistance compared to pre-fabricated and cast metal posts. The data on bond strength and catastrophic failures of CAD-CAM fibre posts must be validated clinically by high-quality, randomised, controlled clinical trials.