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Fracture resistance and microleakage of anterior endocrowns: a systematic review of in vitro studies

British Dental Journal (2025)Cite this article

Abstract

Introduction Endocrowns are increasingly used as alternatives to traditional post-and-core crowns due to their bonding and aesthetic advantages. However, inconsistent clinical outcomes and varying materials and protocols create uncertainty regarding their optimal use, necessitating a systematic review to clarify their properties.

Purpose This review assesses the mechanical properties of anterior endocrown restorations compared to traditional crowns with intracanal posts, such as zirconia and fibre posts. It evaluates different endocrown designs regarding material and ferrule effect, focusing on fracture resistance, marginal adaptation, and pull-out bond strength to inform clinical decision-making.

Methods and materials Following PRISMA guidelines, a comprehensive search of PubMed, Cochrane Library for Cochrane Reviews, Web of Science, Scopus, and Google Scholar was conducted. Studies were included if they assessed the biomechanical behaviour of anterior endocrowns with or without post-and-core comparators. Posterior teeth studies, finite element analyses, animal studies, reviews, and clinical trials were excluded. Of 72 studies identified, 16 met the inclusion criteria. Data were extracted using a standardised form, and risk of bias was assessed with the ROBINS-I tool.

Results In total, 16 in vitro studies were analysed. Most studies indicated that endocrowns demonstrate comparable fracture resistance to post-and-core systems, although marginal adaptation varied. A 2 mm ferrule significantly improved the prognosis.

Conclusion Endocrown restorations for anterior teeth may serve as a viable alternative to post-and-core treatments. Further clinical studies are needed to clarify discrepancies in fracture strength and adaptation and assess long-term success.

Key points

  • Endocrowns show comparable fracture resistance to post-and-core restorations in anterior teeth.

  • A 2 mm ferrule significantly improves their mechanical performance and prognosis.

  • Evidence on marginal adaptation is mixed, warranting further study.

  • Most current data come from in vitro studies; clinical trials are needed to validate findings.

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Data availability

The data extraction forms and datasets generated and analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Associate Professor, Department of Prosthodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

    AmirTaher Mirmortazavi

  2. DDS Student, Pre-graduate, Student Research Committee, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

    Nazanin Salmani, Iman Shiezadeh, Ghazal Asadi & Mina Ahmadi

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  2. Nazanin Salmani
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Contributions

ATM: conceptualisation, methodology, validation, supervision. NS: methodology, writing – original draft, writing – review and editing, project administration. IS: investigation, formal analysis. GA: writing – original draft, data curation. MA: writing – original draft, resources.

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Correspondence to Nazanin Salmani.

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The authors declare that they have no conflicts of interest related to this study. This study is a systematic review of previously published in vitro studies and did not involve human participants or animals; therefore, ethical approval and consent was not required.

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Mirmortazavi, A., Salmani, N., Shiezadeh, I. et al. Fracture resistance and microleakage of anterior endocrowns: a systematic review of in vitro studies. Br Dent J (2025). https://doi.org/10.1038/s41415-025-8912-z

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