DOI: 10.1111/iej.

13607

REVIEW

European Society of Endodontology

position statement: The restoration
of root filled teeth

European Society of Endodontology developed by: | Francesco Mannocci1 |

Bhavin Bhuva1 | Miguel Roig2 | Maciej Zarow3 | Kerstin Bitter4
1
Faculty of Dentistry, Oral & Abstract
Craniofacial Sciences, Department of
This position statement on the restoration of root filled teeth represents the consen-
Endodontics, King's College London,
Guy's Hospital, London, UK sus of an expert committee, convened by the European Society of Endodontology
2
Section for Endodontology, (ESE). Current clinical and scientific evidence, as well as the expertise of the com-
Department of Restorative Dentistry, mittee, have been used to develop this statement. The aim is to provide clinicians
Universitat Internacional de Catalunya,
Barcelona, Spain with evidence-­based principles for decision-­making on the choice of restoration fol-
3
Private Practice, Krakow, Poland lowing the completion of root canal treatment. By discussing the evidence in relation
4
Department of Operative and to key topics regarding post-­endodontic restoration, a series of clinical recommen-
Preventive Dentistry, Charité –­ dations are made. The scientific basis of the recommendations made in this paper
University Medicine, Berlin, Germany
can be found in a recently published review article (Bhuva et al. 2021, International
Correspondence Endodontic Journal, https://doi.org/10.1111/iej.13438). It is the intention of the com-
Paul M. H. Dummer, European Society mittee to update this statement as further evidence emerges.
of Endodontology, Postboks 1237 Vika,
0110 Oslo, Norway.
KEYWORDS
Email: [email protected]
crown, endocrown, onlay, post, restoration, root filled teeth

I N T RO DU CT ION deciding on the most appropriate technique and materials

for the restoration of root filled teeth.
The restoration of the root filled tooth is an essential Root filled teeth may be lost due to post-­treatment end-
component of root canal treatment and should restore odontic disease, unrestorable carious lesions, restorative
the tooth to function, aesthetics and protect the residual failure, irretrievable cusp or crown fracture, vertical root
tooth structure from biological and structural failure. The fracture or periodontal disease. More recently, there has
range of restorative options available to clinicians has in- been a shift in endodontic outcome research, with more
creased with advances in adhesive bonding, improved ce- studies focusing on the overall survival of root filled teeth.
ramics and innovation in digital scanning and fabrication Failure analyses of teeth in these studies include both bi-
processes (Alves de Carvalho et al., 2018). The numerous ological (endodontic) and structural (restorative) causes
choices now available provide great opportunity, but also (Landys Boren et al., 2015; Salehrabi & Rotstein, 2004).
create a potential source of confusion for clinicians when The findings of survival studies have demonstrated that
the quantity of residual sound tooth structure (Al-­Nuaimi
et al., 2017; Nagasiri & Chitmongkolsuk, 2005), as well as
Further additions, comments and consensus by ESE Executive Board the choice of restoration (Aquilino & Caplan, 2002; Pratt
members: Dummer PMH, Duncan HF, Franco V, Galler K, Gambarini
et al., 2016), are the main factors influencing the survival of
G, Kirkevang L-­L, Whitworth J.

© 2021 International Endodontic Journal. Published by John Wiley & Sons Ltd

1974 | wileyonlinelibrary.com/journal/iej
 Int Endod J. 2021;54:1974–1981.
MANNOCCI et al.    | 1975

root filled teeth. These observations are a point of interest in

relation to minimal intervention endodontic philosophies ESE-­approved definitions and terminology/
(Clark & Khademi, 2010; Plotino et al., 2017) and the im- glossary
pact these concepts may have on tooth survival. Although
current evidence in respect of the validity of these concepts
Cracked tooth
on survival outcomes is limited, it is hoped that future clin-
ical research will provide relevant patient-­ centred data An incomplete fracture involving dentine, which
which can be used to reassess the current evidence base. extends from the crown of the tooth in an apical
There are significant challenges in establishing mean- direction. Cracks most commonly present in the
ingful conclusions from the scientific literature in relation mesio-­distal plane in posterior teeth and may ex-
to the impact of post-­endodontic restoration on clinical tend to variable depth within the crown and/or root.
outcomes, and therefore, controversies do, and will, re-
main regarding the most appropriate restorative proce- Endocrown
dures following the completion of root canal treatment. An all-­ ceramic full coverage crown which in-
Study and cohort heterogeneity and the limited number cludes an integrated intra-­ coronal extension
of prospective clinical trials with a high level of evidence which projects into the pulp chamber of a root
complicate the development of management guidelines. filled posterior tooth.
Considering these challenges, the results of well-­designed
survival studies, assessing patient-­ centred outcomes, Ferrule effect
should perhaps, lead to the reconsideration of the prog- An adequate circumferential supramarginal collar
nosis, and therefore, management of compromised teeth. of dentine to retain an extra-­coronal restoration.
These findings are particularly relevant to teeth with
limited residual tooth structure (Al-­Nuaimi et al., 2020)
and also teeth with mild to moderate cracks (Leong et al.,
2020), which appear to show good medium-­term survival. Chitmongkolsuk (2005) recommended that residual walls
should also be of 2 mm thickness. Interestingly, there are
very little further data on this important variable.
1. Clinical evidence on the ferrule effect, In vivo prospective studies with a duration of 5–­17 years
number of cavity walls and residual tooth demonstrate a correlation between the survival of resto-
volume on the survival of root filled teeth rations and root filled teeth in relation to the amount of fer-
rule effect and number of remaining cavity walls (Cloet et al.,
Much of the research on the survival of restorations and 2017; Creugers et al., 2005; Ferrari et al., 2012; Fokkinga
root filled teeth is based on the findings of laboratory stud- et al., 2007). A systematic review on the failure rates of teeth
ies assessing the effect of an adequate ferrule effect on (Naumann et al., 2018a) restored with cores or posts, with
biomechanical performance (Ichim et al., 2006; Juloski and without adequate ferrule effect, found that two of the
et al., 2012; Ma et al., 2009; Sorensen & Engelman, 1990). three selected randomized studies demonstrated the positive
Clinical studies have assessed the importance of the fer- effect of teeth with adequate circumferential supramarginal
rule effect, as well as the number of remaining cavity walls tooth structure (Creugers et al., 2005; Ferrari et al., 2012).
(Cagidiaco et al., 2008; Ferrari et al., 2012), either in combi- A prospective study on molars following root canal re-
nation or isolation. However, there is significant variability treatment suggested an association between larger volumes
in how both the ferrule effect and remaining cavity walls of residual tooth structure and the percentage of favourable
are assessed. The height and thickness of the ferrule effect endodontic treatment outcomes (Al-­Nuaimi et al., 2017).
or residual walls are rarely specified, and in general, de- The 4-­year survival of the same group of teeth proved that
scribed more qualitatively. Several authors have stipulated failure of root canal retreatment at 1 year was a good pre-
a minimum ferrule height of at least 2 mm (Cagidiaco et al., dictor of tooth extraction at 4 years (Al-­Nuaimi et al., 2020).
2008; Ferrari et al., 2012; Mancebo et al., 2010; Naumann
et al., 2007), whilst other authors have assessed the perfor-
mance of teeth with lesser (Setzer et al., 2011) and greater 2. Clinical evidence on the effect of cracks
(Schmitter et al., 2007) ferrule height. A review of the on the survival of root filled teeth
literature on the ferrule effect suggested a minimum fer-
rule height of 1.5–­2.5 mm is required (Juloski et al., 2012). Cracks in root filled teeth should be considered as a sig-
Cloet et al. (2017) suggested that the ferrule effect should nificant factor affecting their survival. However, the di-
have a minimum thickness of 2 mm, whilst Nagasiri and agnosis and prognostication of cracked teeth remains a
1976 |    ESE POSITION STATEMENT: TOOTH RESTORATION

challenge for clinicians. Based on emerging research on canal treatment are three times less likely to be extracted
the survival of root filled teeth with cracks, it would ap- than those restored after 4 months (Pratt et al., 2016).
pear that the location and extent of cracks should not be Currently, no further studies assessing the timing of the
considered in isolation when determining the prognosis. cuspal coverage restoration on the survival of root filled
A prospective study demonstrated 96% survival, over teeth are available, and therefore, the evidence is limited.
a 2-­to-­4-­year period, for crowned root filled teeth with
cracks extending to the level of the canal orifice and up
to 5 mm beyond (Davis & Shariff, 2019). Further evidence Direct or indirect restorations
from a systematic review of 4 retrospective studies sug-
gested a 5-­year survival rate of 84% for teeth with cracks Cuspal protection of root filled premolars and molars has
(Leong et al., 2020). been reported to improve survival, reducing the risk of
biomechanical failure. Whilst there is limited evidence for
crowning anterior root filled teeth, clinical research has
3. Clinical evidence on the effect of tooth revealed a significant correlation between the survival of
location and presence of proximal contacts posterior root filled teeth and the placement of a cuspal
on the survival of root filled teeth coverage restoration. However, each case should be as-
sessed individually with consideration of the following
Root filled teeth are at increased risk of structural failure factors:
as a result of tooth volume loss and the biomechanical
consequences of loss of pulp vitality, as well as those of • tooth structure loss;
subsequent endodontic and restorative treatment. Both • terminal or nonterminal tooth and number of neigh-
the functional and parafunctional stresses imparted on bouring contacts;
the root filled tooth are related to the location and pres- • presence of cracks;
ence of proximal contacts. Terminal teeth and those with- • occlusal factors (excursive/protrusive guidance and
out proximal contacts are more susceptible to crown/root presence of deflective contacts).
fractures, as well as complications such as core failure.
A 4-­to-­10-­year retrospective study (Aquilino & Caplan, Sorensen and Martinoff (1984) studied 1273 root
2002), as well as a further 2-­to-­4-­year prospective study (Ng filled teeth retrospectively for up to 25 years and con-
et al., 2011), demonstrated that terminal teeth (last stand- cluded that cuspal coverage restorations significantly
ing teeth in the arch), and those without neighbouring con- improved long-­ term survival. A 10-­ year retrospective
tacts, have inferior survival to nonterminal teeth (Aquilino study (Landys Boren et al., 2015) including all tooth
& Caplan, 2002; Lazarski et al., 2001) and those with neigh- types, demonstrated that teeth restored with crowns
bouring contacts, respectively (Alley et al., 2004; Aquilino had a higher estimated survival rate (91%) when com-
& Caplan, 2002). Root filled second molar teeth have been pared with those restored with direct restorations (76%).
shown to have the greatest likelihood of catastrophic fail- Similarly, an 8-­ year retrospective study (Pratt et al.,
ure, necessitating extraction (Aquilino & Caplan, 2002). 2016) on posterior teeth concluded that teeth restored
with crowns had a survival rate of 71% versus a survival
rate of 58% for teeth which did not receive cuspal cov-
4. Clinical evidence on the erage. Aquilino and Caplan (2002) observed that root
effect of restoration type and timing on the filled teeth without crowns were extracted 6 times more
survival of root filled teeth frequently than those with crowns, although these find-
ings may be subject to bias, as the included teeth were
The risk of irretrievable fracture or crack development not randomly allocated due to the retrospective study
and propagation pose a significant threat to the survival of design. Within an observation period of 3 years, a ran-
root filled tooth. As well as this, an optimal coronal seal is domized clinical trial (Mannocci et al., 2002) reported
of significant importance. that premolars with limited loss of tooth structure re-
stored with fibre posts and direct composite resin resto-
rations (53 teeth) had a similar restoration failure rate
Timing of restoration placement (4%) to those restored with fibre posts, composite cores
and full coverage crowns (54 teeth). Data provided by
There is evidence from an 8-­year retrospective study that prospective research on the impact of indirect cuspal
root filled posterior teeth restored with cuspal coverage coverage on the survival of root filled teeth is limited to
restorations within 4 months of the completion of root this study.
MANNOCCI et al.    | 1977

Choice of material for crowns and onlays Choice of material for direct
restorations and cores
The rapid evolution of dental materials, particularly com-
posite resin and ceramics has been evident over recent Minimal research exists specifically on the performance of
years. The options available for direct restoration, core amalgam or composite resin as direct restorations in root
materials, posts and cuspal coverage provision are more filled teeth. However, superior survival of root filled pre-
extensive than ever before. molar teeth restored with direct composite restorations
Despite this, there have been no prospective ran- when compared with those restored with direct amalgam
domized controlled clinical trials comparing different restorations was observed in a 5-­year prospective clinical
materials for the construction of crowns and onlays; trial (Mannocci et al., 2005). However, of the teeth which
there is evidence from retrospective research that the survived, those restored with amalgam had less secondary
performance of metal ceramic, all ceramic and indirect caries than those restored with composite.
composite restorations is excellent in medium-­ term Clinicians have a number of choices for core place-
studies of 3–­5 years (Chrepa et al., 2014; Pjetursson ment prior to cuspal coverage restoration. Unfortunately,
et al., 2007; Sailer et al., 2015). Limited long-­term data there are currently no randomized controlled clinical tri-
(25–­30 years) are available for gold (Studer et al., 2000) als comparing amalgam, composite or other materials,
and metal ceramic crowns (Walton, 2013). As a number such as glass ionomer cements, as core materials for root
of different materials are used for all ceramic crown filled teeth restored with crowns.
construction, it is important to acknowledge that fa-
vourable outcomes, albeit limited, have been observed
for leucite, lithium disilicate reinforced glass ceramic 5. Clinical evidence on the effect of
or alumina-­based oxide ceramics. Less favourable out- post-­placement on the survival of root
comes have been observed in posterior teeth restored filled teeth
with glass ceramic and monolithic zirconia crowns
(Sailer et al., 2015). Effect of post-­placement

The use intraradicular posts in root filled teeth has been

Endocrowns versus conventional crowns an area of much discussion and controversy. It is impera-
tive to acknowledge that the purpose of a post is to facili-
An alternative restoration for root filled posterior teeth tate core retention; it does not increase the strength of the
with significant coronal structural loss is the use of endo- root or compensate for the absence of a ferrule effect. With
crowns instead of conventional restorations with posts the evolution of ever-­improving adhesive materials, fewer
and full coverage crowns. The latter requires prepara- teeth require posts, and when indicated, there is certainly
tion of a ferrule design which contributes to additional no reason for additional dentine removal to be carried out
tooth structure loss during preparation, and this may to facilitate post-­placement. Therefore, posts should be
negatively impact the long-­term survival of the restored placed ‘passively’, without mechanical preparation of the
tooth. However, endocrowns are adhesively bonded root canal space (Naumann et al., 2018b).
to the dentine of the pulp chamber; consequently, ad- A systematic review on the survival of root filled teeth
equate isolation of the prepared tooth structure during included eight studies in which posts had been provided.
adhesive cementation of the restoration must be assured Seven of the eight studies did not report an improvement
to achieve optimal long-­term outcomes. In addition, in survival following post-­placement (Naumann et al.,
this restoration type is predominantly recommended 2018a). These findings corroborate the assertion that re-
for molars. Premolars restored with endocrowns have sidual tooth structure, and not the presence or absence of
been reported to have a significantly reduced survival a post, dictates tooth survival.
rate compared to full coverage crowns, mainly due to Root filled teeth with no remaining coronal dentine
decementation which may be attributed to the reduced walls have been shown to benefit from post-­placement
available surface area for adhesive bonding (Bindl et al., (Bitter et al., 2009; Naumann et al., 2018a) whilst teeth
2005). in the maxillary anterior region have been reported to
Root filled molars restored with endocrowns demon- have an increased risk of structural failure due to the
strate similar survival rates compared to full coverage shear forces they are subjected to (Naumann et al., 2005,
crowns with survival greater than 90% after 7 (Fages 2008; Schmitter et al., 2011; Torbjörner & Fransson, 2004).
et al., 2017) and 10 years (Otto & Mormann, 2015) Consequently, posts may be more beneficial in these cases,
respectively. although this requires further evaluation.
1978 |    ESE POSITION STATEMENT: TOOTH RESTORATION

In contrast to molars, premolars have less coronal tooth recommendations are considered as general guidance,
structure volume and smaller pulp chambers to facilitate which can be used to facilitate treatment decision-­making.
the retention of the core placed after the completion of However, clinicians are advised to consider each case indi-
root canal treatment. Moreover, the endodontic access vidually when considering the following recommendations:
cavity increases the possibility of fracture due to cuspal
deflection during function (Göktürk et al., 2018). • The presence of a circumferential ferrule is beneficial for
In summary, anterior teeth and premolars may require the survival of both anterior and posterior root filled teeth.
fibre posts more often than molars (Acquaviva et al., 2011; Wherever possible, clinicians should make every effort to
Ferrari et al., 2007). A recent classification system for root obtain an optimal ferrule when planning indirect resto-
filled teeth (Zarow et al., 2018) recommended the use of rations. The absence of an adequate ferrule effect is asso-
fibre posts in anterior and premolar teeth with significantly ciated with reduced tooth and restoration survival.
compromised tooth structure. These recommendations • In most cases, when at least one proximal wall is miss-
are based on the findings of studies assessing the effect ing, root filled premolars and molars should be restored
of remaining walls on tooth survival (Ferrari et al., 2012; with cuspal coverage restorations. However, restorations
Guldener et al., 2017). should always be designed conservatively and onlay res-
torations utilized where appropriate, with the aim of
retaining as much sound residual tooth structure as pos-
Fibre or metal posts sible. Tooth reduction should be carried out according to
requirements of the material used for the indirect resto-
Gold alloy or Cobalt-­Chromium-­based cast posts and cores ration and excessive preparation must be avoided. There
have been used successfully to restore root filled teeth, dem- may be scenarios where cuspal coverage of a posterior
onstrating success rates of 84%–­94% after 10 years (Cloet tooth is not considered necessary, for example, in cases
et al., 2017; Ellner et al., 2003; Ferrari et al., 2000). However, with only a Class 1 cavity and where the residual walls
one disadvantage of their use is the additional removal of are of adequate thickness, and no cracks are present, or
peri-­cervical root canal dentine for post-­space preparation in scenarios where there is no opposing tooth. Clinicians
and the potential risk of coronal leakage during tempori- should consider each case individually, having given care-
zation. Flexible post-­systems, for example fibre posts, have ful consideration to the overall tooth structure loss, thick-
been developed with the concept of facilitating more uni- ness of the residual dentine walls, tooth location, number
form stress distribution compared to higher-­stiffness materi- of neighbouring contacts, absence/presence of cracks and
als which have been purported to predispose root filled teeth occlusal factors. Furthermore, consideration of the im-
to root fracture. To date, no clinical evidence exists that the pact of minimal intervention endodontic-­restorative tech-
use of fibre posts reduces the occurrence of root fractures in niques may influence the decision-­making process.
vivo (Figueiredo et al., 2015; Naumann et al., 2017). Further • Terminal teeth, particularly in patients with parafunc-
prospective clinical data has not demonstrated the superior- tional habits, require detailed occlusal assessment and
ity of either rigid or flexible posts on tooth and/or restora- appropriate restorative management to prevent further
tion survival (Cloet et al., 2017; Sarkis-­Onofre et al., 2014; complications.
Sterzenbach et al., 2012). Despite one clinical trial revealing • Careful attention should be paid to existing premature oc-
a significantly greater survival rate for fibre posts compared clusal interferences as part of the post-­endodontic restor-
to metal screw posts (Schmitter et al., 2011) and a recent ative process.
meta-­ analysis concluding significantly higher mid-­ term • Cracked teeth should routinely be restored with cuspal
survival rates for fibre posts compared to metal posts (Wang coverage restorations following endodontic treatment.
et al., 2019) it can be concluded that currently no evidence Options for cracked teeth should be discussed with pa-
exists that the choice of post-­material affects the survival of tients so that they are able to make an informed deci-
root filled teeth. sion on the prognosis and whether the tooth should be
retained. Decision-­making should not be solely based on
the location and extent of detected cracks. Furthermore,
RECO M M E N DAT ION S FOR T H E cracked teeth require careful clinical and radiographic
RESTO RAT I O N OF ROOT F ILLED follow-­up to monitor potential attachment and bone loss
T E ET H which may develop from crack propagation and which
may compromise future replacement options such as im-
The development of evidence-­based guidelines for the res- plant placement.
toration of root filled teeth is complex with a multitude of • The placement of a post-­specifically in teeth with no re-
factors that require consideration. However, the following maining coronal dentine walls is beneficial, particularly
MANNOCCI et al.    | 1979

Alley, B.S., Kitchens, G.G., Alley, L.W. & Eleazer, P.D. (2004) A com-
in anterior and premolar teeth. However, in all other parison of survival of teeth following endodontic treatment per-
situations (including molar teeth), post-­placement does formed by general dentists or by specialists. Oral Surgery, Oral
not improve restoration or tooth survival. The benefit of Medicine, Oral Pathology, Oral Radiology and Endodontology,
enhanced core retention that may be achieved with post-­ 98, 115–­118.
placement should be considered against the potential Al-­Nuaimi, N., Ciapryna, S., Chia, M., Patel, S. & Mannocci, F.
dentine removal required. Additional (mechanical) den- (2020) A prospective study on the effect of coronal tooth struc-
tine removal for post-­placement should be avoided and ture loss on the 4-­year clinical survival of root canal retreated
teeth, and retrospective validation of the Dental Practicality
‘passive’ post-­placement employed wherever possible.
Index. International Endodontic Journal, 53, 1040–­1049.
• Currently, there is no clinical evidence that the material of Al-­Nuaimi, N., Patel, S., Austin, R.S. & Mannocci, F. (2017) A pro-
the post, either rigid or flexible, affects the survival rate of spective study assessing the effect of coronal tooth structure
root filled teeth restored with posts. If posts are adhesively loss on the outcome of root canal retreatment. International
luted, all steps of the designated bonding protocol should Endodontic Journal, 50, 1143–­1157.
be followed. A clean and adequately prepared dentine Alves de Carvalho, I.F., Marques, S., Araújo, F.M., Azevedo, L.F.,
surface appears to be more important for the success of Donato, H. & Correia, A. (2018) Clinical performance of CAD/
CAM tooth-­supported ceramic restorations: A systematic re-
the restoration than the choice of post-­material.
view. The International Journal of Periodontics & Restorative
• Endocrowns can be considered as an appropriate alter-
Dentistry, 38, e68–­e78.
native to conventional post-­ retained full coverage res- Aquilino, S.A. & Caplan, D.J. (2002) Relationship between crown
torations for root filled molar teeth, permitting greater placement and the survival of endodontically treated teeth.
preservation of residual tooth structure. However, it is Journal of Prosthetic Dentistry, 87, 256–­263.
imperative that the correct adhesive luting protocol is fol- Bhuva, B., Giovarruscio, M., Rahim, N., Bitter, K. & Mannocci, F.
lowed to ensure the success of these restorations. (2021) The restoration of root filled teeth: a review of the clin-
ical literature. International Endodontic Journal, 54, 509–­535.
Bindl, A., Richter, B. & Mormann, W.H. (2005) Survival of ce-
Prospective studies assessing the survival of root
ramic computer-­aided design/manufacturing crowns bonded
filled teeth treated with minimal intervention endodon- to preparations with reduced macroretention geometry.
tic and restorative techniques, including teeth restored International Journal of Prosthodontics, 18, 219–­224.
with and without cuspal coverage restoration will Bitter, K., Noetzel, J., Stamm, O., Vaudt, J., Meyer-­ Lueckel, H.,
offer insight into the effect of dentine preservation on Neumann, K. et al. (2009) Randomized clinical trial comparing
tooth survival. It is hoped that future clinical research the effects of post placement on failure rate of postendodon-
will provide tangible outcome studies to compare the tic restorations: preliminary results of a mean period of 32
application of these concepts with more traditional months. Journal of Endodontics, 35, 1477–­1482.
Cagidiaco, M.C., García-­Godoy, F., Vichi, A., Grandini, S., Goracci,
philosophies.
C. & Ferrari, M. (2008) Placement of fiber prefabricated or cus-
tom made posts affects the 3-­year survival of endodontically
CONFLICT OF INTEREST treated premolars. American Journal of Dentistry, 21, 179–­184.
The authors confirm they have no conflict of interest. Chrepa, V., Konstantinidis, I., Kotsakis, G.A. & Mitsias, M.E. (2014)
The survival of indirect composite resin onlays for the resto-
AUTHOR CONTRIBUTION ration of root filled teeth: a retrospective medium-­term study.
All authors contributed equally to the development of the International Endodontic Journal, 47, 967–­973.
Clark, D. & Khademi, J. (2010) Modern molar endodontic access and
manuscript.
directed dentin conservation. Dental Clinics, 54, 249–­273.
Cloet, E., Debels, E. & Naert, I. (2017) Controlled clinical trial on
ORCID the outcome of glass fiber composite cores versus wrought
Francesco Mannocci https://orcid. posts and cast cores for the restoration of endodontically
org/0000-0002-0560-1054 treated teeth: a 5-­year follow-­up study. International Journal of
Bhavin Bhuva https://orcid.org/0000-0002-5413-9134 Prosthodontics, 30, 71–­79.
Miguel Roig https://orcid.org/0000-0002-4872-4118 Creugers, N.H., Mentink, A.G., Fokkinga, W.A. & Kreulen, C.M.
Maciej Zarow https://orcid.org/0000-0001-7870-2115 (2005) 5-­ year follow-­ up of a prospective clinical study on
various types of core restorations. International Journal of
Kerstin Bitter https://orcid.org/0000-0002-4458-8331
Prosthodontics, 18, 34–­39.
Davis, M.C. & Shariff, S.S. (2019) Success and survival of endodon-
REFERENCES tically treated cracked teeth with radicular extensions: a 2-­to
Acquaviva, P.A., Madini, L., Krokidis, A., Gagliani, M., Mangani, 4-­year prospective cohort. Journal of Endodontics, 45, 848–­855.
F. & Cerutti, A. (2011) Adhesive restoration of endodontically Ellner, S., Bergendal, T. & Bergman, B. (2003) Four post-­and-­core
treated premolars: influence of posts on cuspal deflection. combinations as abutments for fixed single crowns: a prospec-
Journal of Adhesive Dentistry, 13, 279–­286. tive up to 10-­year study. International Journal of Prosthodontics,
16, 249–­254.
1980 |    ESE POSITION STATEMENT: TOOTH RESTORATION

Fages, M., Raynal, J., Tramini, P., Cuisinier, F.J. & Durand, J.C. (2017) Mannocci, F., Qualtrough, A.J., Worthington, H.V., Watson, T.F. &
Chairside computer-­aided design/computer-­aided manufacture Pitt Ford, T.R. (2005) Randomized clinical comparison of end-
all-­ceramic crown and endocrown restorations: a 7-­year survival odontically treated teeth restored with amalgam or with fiber
rate study. International Journal of Prosthodontics, 30, 556–­560. posts and resin composite: five-­year results. Operative Dentistry,
Ferrari, M., Cagidiaco, M.C., Goracci, C., Vichi, A., Mason, P.N., 30, 9–­15.
Radovic, I. et al. (2007) Long-­ term retrospective study of Nagasiri, R. & Chitmongkolsuk, S. (2005) Long-­term survival of end-
the clinical performance of fiber posts. American Journal of odontically treated molars without crown coverage: a retrospec-
Dentistry, 20, 287–­291. tive cohort study. Journal of Prosthetic Dentistry, 93, 164–­170.
Ferrari, M., Vichi, A. & Garcia-­Godoy, F. (2000) Clinical evaluation Naumann, M., Blankenstein, F., Kiessling, S. & Dietrich, T. (2005)
of fiber-­reinforced epoxy resin posts and cast post and cores. Risk factors for failure of glass fiber-­ reinforced composite
American Journal of Dentistry, 13, 15B–­18B. post restorations: a prospective observational clinical study.
Ferrari, M., Vichi, A., Fadda, G.M., Cagidiaco, M.C., Tay, F.R., European Journal of Oral Sciences, 113, 519–­524.
Breschi, L. et al. (2012) A randomized controlled trial of end- Naumann, M., Preuss, A. & Frankenberger, R. (2007) Reinforcement
odontically treated and restored premolars. Journal of Dental effect of adhesively luted fibre reinforced composite versus tita-
Research, 91, S72–­S78. nium posts. Dental Materials, 23, 138–­144.
Figueiredo, F.E., Martins-­Filho, P.R. & Faria, E.S.A.L. (2015) Do Naumann, M., Reich, S., Nothdurft, F.P., Beuer, F., Schirrmeister,
metal post-­retained restorations result in more root fractures J.F. & Dietrich, T. (2008) Survival of glass fiber post restorations
than fiber post-­retained restorations? A systematic review and over 5 years. American Journal of Dentistry, 21, 267–­272.
meta-­analysis. Journal of Endodontics, 41, 309–­316. Naumann, M., Schmitter, M., Frankenberger, R. & Krastl, G. (2018a)
Fokkinga, W.A., Kreulen, C.M., Bronkhorst, E.M. & Creugers, N.H. Ferrule comes first. Post is second!" Fake news and alternative
(2007) Up to 17-­year controlled clinical study on post-­and-­cores facts? A systematic review. Journal of Endodontics, 44, 212–­219.
and covering crowns. Journal of Dentistry, 35, 778–­786. Naumann, M., Schmitter, M. & Krastl, G. (2018b) Postendodontic
Göktürk, H., Karaarslan, E.Ş., Tekin, E., Hologlu, B. & Sarıkaya, I. restoration: endodontic post-­and-­core or no post at all. Journal
(2018) The effect of the different restorations on fracture resis- of Adhesive Dentistry, 20, 19–­24.
tance of root-­filled premolars. BMC Oral Health, 18, 1–­8. Naumann, M., Sterzenbach, G., Dietrich, T., Bitter, K., Frankenberger,
Guldener, K.A., Lanzrein, C.L., Siegrist Guldener, B.E., Lang, N.P., R. & von Stein-­Lausnitz, M. (2017) Dentin-­like versus rigid end-
Ramseier, C.A. & Salvi, G.E. (2017) Long-­term clinical out- odontic post: 11-­year randomized controlled pilot trial on no-­
comes of endodontically treated teeth restored with or with- wall to 2-­wall defects. Journal of Endodontics, 43, 1770–­1775.
out fibre post-­ retained single-­unit restorations. Journal of Ng, Y.L., Mann, V. & Gulabivala, K. (2011) A prospective study of
Endodontics, 43, 188–­193. the factors affecting outcomes of non-­surgical root canal treat-
Ichim, I., Kuzmanovic, D.V. & Love, R.M. (2006) A finite element ment: part 2: tooth survival. International Endodontic Journal,
analysis of ferrule design on restoration resistance and distri- 44, 610–­625.
bution of stress within a root. International Endodontic Journal, Otto, T. & Mormann, W.H. (2015) Clinical performance of chair-
39, 443–­452. side CAD/CAM feldspathic ceramic posterior shoulder crowns
Juloski, J., Radovic, I., Goracci, C., Vulicevic, Z.R. & Ferrari, M. and endocrowns up to 12 years. International Journal of
(2012) Ferrule effect: a literature review. Journal of Endodontics, Computerized Dentistry, 18, 147–­161.
38, 11–­19. Pjetursson, B.E., Sailer, I., Zwahlen, M. & Hämmerle, C.H. (2007)
Landys Boren, D., Jonasson, P. & Kvist, T. (2015) Long-­term survival A systematic review of the survival and complication rates of
of endodontically treated teeth at a public dental specialist all-­ceramic and metal–­ceramic reconstructions after an obser-
clinic. Journal of Endodontics, 41, 176–­181. vation period of at least 3 years. Part I: single crowns. Clinical
Lazarski, M.P., Walker, W.A. III, Flores, C.M., Schindler, W.G. & Oral Implants Research, 18, 73–­85.
Hargreaves, K.M. (2001) Epidemiological evaluation of the out- Plotino, G., Grande, N.M., Isufi, A., Ioppolo, P., Pedullà, E., Bedini,
comes of nonsurgical root canal treatment in a large cohort of R. et al. (2017) Fracture strength of endodontically treated teeth
insured dental patients. Journal of Endodontics, 27, 791–­796. with different access cavity designs. Journal of Endodontics, 43,
Leong, D., de Souza, N.N., Sultana, R. & Yap, A.U. (2020) Outcomes 995–­1000.
of endodontically treated cracked teeth: a systematic review Pratt, I., Aminoshariae, A., Montagnese, T.A., Williams, K.A.,
and meta-­analysis. Clinical Oral Investigations, 24, 465–­473. Khalighinejad, N. & Mickel, A. (2016) Eight-­year retrospective
Ma, P.S., Nicholls, J.I., Junge, T. & Phillips, K.M. (2009) Load fatigue study of the critical time lapse between root canal completion
of teeth with different ferrule lengths, restored with fiber posts, and crown placement: its influence on the survival of endodon-
composite resin cores, and all-­ceramic crowns. The Journal of tically treated teeth. Journal of Endodontics, 42, 1598–­1603.
Prosthetic Dentistry, 102, 229–­234. Sailer, I., Makarov, N.A., Thoma, D.S., Zwahlen, M. & Pjetursson,
Mancebo, J.C., Jimenez-­Castellanos, E. & Canadas, D. (2010) Effect B.E. (2015) All-­ceramic or metal-­ceramic tooth-­supported fixed
of tooth type and ferrule on the survival of pulpless teeth re- dental prostheses (FDPs)? A systematic review of the survival
stored with fibre posts: a 3-­year clinical study. American Journal and complication rates. Part I: Single crowns (SCs). Dental
of Dentistry, 23, 351–­356. Materials, 31, 603–­623.
Mannocci, F., Bertelli, E., Sherriff, M., Watson, T.F. & Pitt Ford, T.R. Salehrabi, R. & Rotstein, I. (2004) Endodontic treatment outcomes
(2002) Three-­year clinical comparison of survival of endodon- in a large patient population in the USA: an epidemiological
tically treated teeth restored with either full cast coverage or study. Journal of Endodontics, 30, 846–­850.
with direct composite restoration. The Journal of Prosthetic Sarkis-­Onofre, R., Jacinto, R.C., Boscato, N., Cenci, M.S. & Pereira-­
Dentistry, 88, 297–­301. Cenci, T. (2014) Cast metal vs. glass fibre posts: a randomized
MANNOCCI et al.    | 1981

controlled trial with up to 3 years of follow up. Journal of with their analysis of failures. Journal of Oral Rehabilitation,
Dentistry, 42, 582–­587. 27, 461–­472.
Schmitter, M., Doz, P., Rammelsberg, P., Gabbert, O. & Ohlmann, Torbjörner, A. & Fransson, B. (2004) A literature review on the
B. (2007) Influence of clinical baseline findings on the survival prosthetic treatment of structurally compromised teeth.
of 2 post systems: a randomized clinical trial. International International Journal of Prosthodontics, 17, 369–­376.
Journal of Prosthodontics, 20, 173–­178. Walton, T.R. (2013) The up to 25-­year survival and clinical perfor-
Schmitter, M., Hamadi, K. & Rammelsberg, P. (2011) Survival of two mance of 2,340 high gold-­based metal-­ceramic single crowns.
post systems–­five-­year results of a randomized clinical trial. International Journal of Prosthodontics, 26, 151–­160.
Quintessence International, 42, 843–­850. Wang, X., Shu, X., Zhang, Y., Yang, B., Jian, Y. & Zhao, K. (2019)
Setzer, F.C., Boyer, K.R., Jeppson, J.R., Karabucak, B. & Kim, S. Evaluation of fiber posts vs metal posts for restoring severely
(2011) Long-­term prognosis of endodontically treated teeth: a damaged endodontically treated teeth: a systematic review and
retrospective analysis of preoperative factors in molars. Journal meta-­analysis. Quintessence International, 50, 8–­20.
of Endodontics, 37, 21–­25. Zarow, M., Ramírez-­Sebastià, A., Paolone, G., de Ribot, P.J., Mora, J.,
Sorensen, J.A. & Engelman, M.J. (1990) Ferrule design and fracture Espona, J. et al. (2018) A new classification system for the res-
resistance of endodontically treated teeth. Journal of Prosthetic toration of root filled teeth. International Endodontic Journal,
Dentistry, 63, 529–­536. 51, 318–­334.
Sorensen, J.A. & Martinoff, J.T. (1984) Intracoronal reinforcement
and coronal coverage: a study of endodontically treated teeth.
Journal of Prosthetic Dentistry, 51, 780–­784. How to cite this article: European Society of
Sterzenbach, G., Franke, A. & Naumann, M. (2012) Rigid versus Endodontology developed by: Mannocci, F., Bhuva,
flexible dentine-­like endodontic posts-­clinical testing of a bio- B., Roig, M., Zarow, M. & Bitter, K. (2021) European
mechanical concept: seven-­year results of a randomized con-
Society of Endodontology position statement: The
trolled clinical pilot trial on endodontically treated abutment
teeth with severe hard tissue loss. Journal of Endodontics, 38,
restoration of root filled teeth. International
1557–­1563. Endodontic Journal, 54, 1974–­1981. https://doi.
Studer, S.P., Wettstein, F., Lehner, C., Zullo, T.G. & Schärer, P. (2000) org/10.1111/iej.13607
Long-­term survival estimates of cast gold inlays and onlays