Postendodontic Restoration: Endodontic Post-and-Core or No Post At All?

Purpose: The objective of this systematic review was to assess the impact of endodontic post insertion on the clinical performance of endodontically treated teeth (ETT). Materials and Methods: A specific PICO question was developed and a Medline search was performed in January 2017 using relevant terms in order to identify studies comparing the success/survival of dental restorations using endodontic posts or no posts. Additionally, the electronic databases "Opengrey", "BBO", "LILAC" and "IBECS" were assessed and a hand search of cross references from original articles and reviews was performed. The methodological quality of the included studies was assessed independently by three referees using (1) the critical appraisal skills program (CASP) and (2) Cochrane checklist (version 5.1.0). Results: A total of 14 studies were included, among them 11 randomized controlled trials (RCT), two prospective clinical trials, and one retrospective clinical trial. The overall quality of the studies was good according to the CASP. However, the Cochrane rating showed that in seven studies, the risk of bias was high in > 40% of the items, indicating a relevant level of methodological flaws. Three studies showed a low risk of bias in > 80% of the items. The majority (10 out of 14) of the clinical studies included failed to show a positive effect of post placement. A post effect is possible when no cavity wall is present. Conclusion: There is no unequivocal clinical evidence to support or reject the use of posts even for no-wall cavities, either for direct or indirect restorations.