Fiber Posts Associated With Better Survival and Fewer Catastrophic Root Fractures: Study
Saudi Arabia: A new study has found that fiber posts demonstrate the most favorable clinical outcomes, primarily by reducing the risk of catastrophic root fractures. In contrast, metallic and custom-made posts were linked to higher complication rates. Additionally, crown material, arch location, and patient-related factors significantly influenced overall tooth survival, highlighting the importance of individualized treatment planning.
These findings were reported in the Journal of Functional Biomaterials by Ali Alenezi and Hanin Alsalhi from Qassim University, Buraidah, Saudi Arabia. The retrospective study assessed the long-term clinical performance of crown restorations supported by different endodontic post systems.
The analysis included 437 endodontically treated teeth restored with crowns and retained using fiber, metallic, or custom-made posts at Qassim University Dental Hospital between August and November 2025. Both clinical and radiographic records were reviewed. The researchers documented biological complications, such as secondary caries and periapical lesions, as well as technical issues, including debonding, root or crown fractures, and ceramic chipping.
The analysis revealed the following findings:
- The mean follow-up duration was 6.76 ± 4.88 years.
- The overall complication rate was 56.8%.
- Fiber posts had the lowest complication rate at 40%.
- Fiber posts achieved the highest 15-year cumulative survival rate at 52%.
- Custom-made posts showed a 38% cumulative survival rate at 15 years.
- Metallic posts demonstrated the poorest outcomes, with only 15% 15-year cumulative survival.
- Metallic posts were associated with a significantly higher risk of complications compared to fiber posts (HR 1.70).
- Female sex was linked to an increased risk of complications (HR 1.69).
- Mandibular tooth location was associated with a higher complication risk (HR 1.36).
- Metal–ceramic crowns showed a protective effect compared to ceramic crowns (HR 0.56).
The authors noted that procedural variability inherent to retrospective designs may have influenced outcomes. Multivariable Cox modeling was not applied due to substantial missing data for key covariates, as this could have introduced bias and reduced statistical reliability. Therefore, the differences observed among post systems should be interpreted as associations rather than direct causal effects. Unmeasured biomechanical and patient-related factors may also have contributed to the results.
The researchers emphasized the need for prospective studies with standardized outcome definitions to better understand the interaction between post type, crown material, and patient risk factors. They also suggested that future investigations incorporating finite element analysis could offer further biomechanical insight into stress distribution patterns among different post systems.
Overall, the findings indicate that post selection plays a critical role in the long-term prognosis of crowned, endodontically treated teeth. Fiber posts appear to provide superior durability, while careful consideration of crown material and patient-related factors remains essential to enhance restoration longevity.
Reference:
Alenezi, A., & Alsalhi, H. (2026). Clinical Outcomes and Complication Rates of Crown Restorations with Various Endodontic Posts: A Retrospective Analysis. Journal of Functional Biomaterials, 17(2). https://doi.org/10.3390/jfb17020084
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