“Ferrule Comes First. Post Is Second!” Fake News and Alternative Facts? A Systematic Review

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Introduction:Both the role of an endodontic post and the ferrule effect have been discussed for decades. The clinical impact of endodontic posts compared with post-free restoration with or without ferrule support was not systematically reviewed so far. It was assumed that the effect of an endodontic post compared with a post-free restoration can be evaluated only when at the same time a ferrule or no-ferrule situation was clinically compared.Methods:The specific PICO question was as follows: Patient: adults with sufficient endodontic treatment needing a core or post; Intervention: post-endodontic treatment using posts with or without ferrule; Comparison: post-endodontic treatment without posts with or without ferrule; Outcomes: failure rates of post/core complexes with or without ferrule support. A Medline search was performed via PubMed in June 2017 using relevant electronic databases. Additionally, hand search was performed. Only prospective clinical studies in humans comparing the success/survival of teeth restored with or without posts over a minimum time of observation of 5 years were included.Results:In total, 7 randomized controlled trials and 1 prospective clinical trial met inclusion criteria. Cochrane rating showed high risk of bias in 5 studies. Two of 3 studies support the ferrule-effect concept. Seven of 8 show no post effect. Clinical evidence regarding the influence of tooth location on its survival is scarce.Conclusion:Ferrule effect and maintaining cavity walls are the predominant factors with regard to tooth and restoration survival of endodontically treated teeth. Most studies do not confirm a positive effect of post placement.Highlights:This article highlights post impact on tooth survival based on long-term clinical research.Post effect can only be evaluated when ferrule vs no-ferrule situation are clinically compared.Two of 3 included studies support the ferrule-effect concept.Only 1 out of 8 studies found a post effect.After up to 17 years of clinical observation a post effect is not as obvious as expected.

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