Endocrowns: A systematic review

Statement of problem: The restoration of extensively damaged endodontically treated teeth remains a challenge. The use of post-retained restorations has been questioned because of potential tooth weakening.

Purpose: The purpose of this systematic review was to determine whether endocrowns are a reliable alternative to post-retained restorations for extensively damaged endodontically treated teeth and to determine which preparation design is most appropriate and which materials are best adapted for fabricating endocrowns.

Material and methods: The literature that was analyzed covered endocrowns from 1995 to June 2018. A search was conducted for in vitro and clinical studies in English in 3 research databases (PubMed, Cochrane, and Scopus), and this was complemented by a manual search in the bibliographies of the studies found. Case reports were excluded.

Results: A total of 41 publications consisting of 8 clinical studies and 33 in vitro studies were included in this systematic review. Several analysis parameters were identified: for the clinical studies, survival rate, failure modes, and clinical criteria; for the in vitro studies, fracture resistance, stress distribution, preparation criteria, and materials used.

Conclusions: Endocrowns are a reliable alternative to post-retained restorations for molars and seem promising for premolars. A certain preparation design and a rigorous adhesion protocol must be respected. Among the available materials, lithium disilicate glass-ceramic and nanofilled composite resin stand out.