Influence of Post-Core and Crown Type on the Fracture Resistance of Incisors Submitted to Quasistatic Loading

Effects of glass fibers reinforced and non-reinforced composite resin on fracture behavior of severely destructed primary incisors and restored with post and core system

Objective

To evaluate fracture resistance and failure type of coronally rehabilitated primary incisors with EverX Flow or Grandio Core post and core with or without fiber post.

Materials and Methods

Forty-eight extracted maxillary primary incisors were root canal treated and obturated with Metapex. The coronal 4-mm of Metapex was removed to create 3-mm intracanal post space. Next, coronal enamel and radicular dentin surfaces were acid-etched, and a bonding agent was applied and light-cured. Based on intracanal post and 2-mm height core buildup materials, specimens were divided equally (n = 12) into 4 groups as follow; Group I (EverX Flow), Group II (Grandio Core), Group III (Fiber post, and EverX Flow), and Group IV(Fiber post and Grandio Core). The coronal restorations were finalized to 4-mm height using G-aenial Anterior composite and specimens were tested for fracture resistance. Force required to induce fracture was recorded and failure type was examined.

Results

Fracture resistance of Fiber post and EverX Flow group was statistically significant high than other tested groups. However, fracture resistance of EverX Flow group showed non-statistically significant difference from that of Fiber post and Grandio Core group. Regarding failure type, no specimen presented root fracture, and all failures were favorable and repairable.

Conclusion

EverX flow post and core with or without fiber post enhanced fracture resistance of restored primary incisors compared to Grandio Core alone.

Clinical relevance

EverX flow post and core system with or without fiber post could be a promising restorative option for severely destructed primary incisors.

Assessing the Efficacy of Novel Fiber-Reinforced Dual-Cure Luting Resins

Background

Dual-cure resin-based luting materials are increasingly favored in clinical applications due to their capacity to establish a strong bond with natural tooth structure and restorations. This study aimed to examine certain physical and handling characteristics of newly developed experimental dual-cure luting resins reinforced with short fibers (SFRCs) and compare them with commercially available dual-cure luting resins.

Material and Methods

Seven dual-cure luting materials were tested (Relyx Ultimate, Duo-Link, eCEMENT, Variolink Esthetic, G-CEM LinkForce, experimental SFRC1, experimental SFRC2). Fourier transform infrared spectroscopy (FTIR) was utilized to determine the degree of monomer conversion (DC%) in the self and light-curing protocol. A rotating disk rheometer measured viscosity at room temperature (22°C) and simulated mouth temperature (35°C). Fracture toughness, flexural strength, and flexural modulus were evaluated using a 3-point bending test. Each luting resin was subjected to the examination of its surface microstructure using scanning electron microscopy (SEM). Analysis of variance (ANOVA) at a significance level of (p = 0.05) was conducted to analyze data.

Results

It was revealed that DC% of the tested dual-cure resins was significantly (p< 0.05) affected by the curing mode, the dual-cure SFRC2 having the highest and Relyx having the lowest DC (64%, and 41% respectively). The viscosity of all tested materials decreased with increasing temperature. SFRC2 demonstrated the highest fracture toughness (2.3 MPa m1/2), while Relyx Ultimate, Duo-Link, and eCEMENT exhibited the lowest values (≈ 1 MPa m1/2)(p< 0.05). Both SFRCs and G-CEM link-force exhibited the highest flexural strength values, and SFRCs resulted in the highest flexural modulus values (p<0.05).

Conclusions

The experimental fiber-reinforced dual-cure luting resins exhibited superior DC%, fracture toughness, and flexural properties, yet, SFRC2 showed the highest viscosity at elevated temperature. These results highlight the capability of short fiber reinforcement to enhance the mechanical properties of dual-cured resin-based luting materials without compromising handling characteristics. Key words:Dual-cure luting resin; short fibers; degree of conversion; viscosity; fracture toughness; flexural properties.

Influence of Different Post-endodontic Restorations on the Survival Rate Against Fracture of Endodontically Treated Anterior Teeth Affected by Cervical Lesions with Pulpal Involvement: A Retrospective Clinical Study

OBJECTIVE

To compare the survival rate against fracture of endodontically treated anterior teeth (ETT) affected by cervical (class V) lesions with pulpal involvement restored with resin composite or a post/core and crown, and to identify the prognostic factors for fracture.

METHODS

Dental records and radiographs of ETT affected by cervical lesions with pulpal involvement restored with resin composite or a post/core and crown during a recall period from 2009-2022 were selected according to the inclusion and exclusion criteria. The number of tooth fracture, the restorability after fracture and any possible risk factors were identified. The survival rate against ETT fracture were analyzed and com- pared between the two restoration groups by Kaplan-Meier survival analysis and the Tarone-Ware test. Non- proportional hazard models were used to identify the prognostic factors. The sub-analysis in each restoration group was also performed.

RESULTS

The study comprised 175 ETT restored with resin composite (n=125) or a crown (n=50). With a mean recall period of 32.9+-15.8 months, the survival rate against ETT fracture with resin composite (85.6%) was not significantly different from those with a crown (88%) (p≥0.05). The most frequent mode of fracture was crown-root fracture, which accounted for 78% and 83.30% of the fractures in the resin composite and crown groups, respectively. A significant prognostic factor for ETT fracture affected by cervical lesions with pulpal involve- ment was additional tooth structure loss from a class III, class IV or another class V lesion on the opposite side (p<0.05). The ETT affected by cervical lesions with pulpal involvement combined with additional tooth structure loss had a 7.25-fold higher risk of fracture than those with single-surface affected by cervical lesions with pulpal involvement (hazard ratio [HR] = 7.25; 95% confidence interval [CI], 1.68-31.30). The sub-analysis in the crown and resin composite groups revealed that the survival rates of ETT with single-surface affected by cervical lesions with pulpal involvement was 100% and 96.15%, respectively, which were significantly higher than those of ETT with additional tooth loss at 80.65% and 78.08%, respectively (p<0.05).

CONCLUSION

With a mean 33-month recall period, the survival rate against ETT fracture affected by cervical lesions with pulpal involvement restored with resin composite or crown were not significantly different. Additional tooth structure loss was a significant prognostic factor for fracture.

Fracture behavior of short fiber-reinforced CAD/CAM inlay restorations after cyclic fatigue aging

The aim of this study was to assess the fracture behavior of molar teeth restored with MOD inlays made of experimental short fiber-reinforced CAD/CAM composite block (SFRC CAD) before and after cyclic fatigue aging. Standardized MOD cavities were prepared on 60 intact mandibular molars. Three groups of CAD/CAM made inlay restorations (Cerasmart 270, Enamic, and SFRC CAD) were fabricated (n = 20/group). All restorations were luted with self-adhesive dual-cure resin cement (G-Cem One). Half of restored teeth per each group (n = 10) were quasi-statically loaded until fracture without aging. The other half underwent cyclic fatigue aging for 500,000 cycles (Fmax = 150 N) before being loaded quasi-statically until fracture. Then, the fracture type was visually inspected. The microstructure and elemental content of CAD/CAM materials were assessed using SEM and EDS. Two-way analysis of variance (ANOVA) was used to statistically examine the data, and it was followed by the Tukey HSD test (α = 0.05). ANOVA demonstrated that both material type and aging had a significant effect (p < 0.05) on the load-bearing capacity values of the restorations. Teeth restored with SFRC CAD showed significantly the highest (p < 0.05) load-bearing capacity (2535 ± 830 N) after fatigue aging among all groups. SEM images showed the ability of short fibers in SFRC CAD composite to redirect and hinder crack propagation. With regard to fracture mode, Enamic group revealed 85% of catastrophic failure (vs. 45% and 10% for Cerasmart 270 and SFRC CAD, respectively). Large MOD cavities on molar teeth were most favorably restored with SFRC CAD inlays, yielding the highest load-bearing capacity and more restorable failures.

Recent Advances in 3D Printing of Polymers for Application in Prosthodontics

Contemporary mass media frequently depict 3D printing as a technology with widespread utilization in the creation of dental prosthetics. This paper endeavors to provide an evidence-based assessment of the current scope of 3D printing's integration within dental laboratories and practices. Its primary objective is to offer a systematic evaluation of the existing applications of 3D-printing technology within the realm of dental prosthetic restorations. Furthermore, this article delves into potential prospects, while also critically examining the sustained relevance of conventional dental laboratory services and manufacturing procedures. The central focus of this article is to expound upon the extent to which 3D printing is presently harnessed for crafting dental prosthetic appliances. By presenting verifiable data and factual insights, this article aspires to elucidate the actual implementation of 3D printing in prosthetic dentistry and its seamless integration into dental practices. The aim of this narrative review is twofold: firstly, to provide an informed and unbiased evaluation of the role that 3D printing currently plays within dental laboratories and practices; and secondly, to instigate contemplation on the transformative potential of this technology, both in terms of its contemporary impact and its future implications, while maintaining a balanced consideration of traditional dental approaches.

Particulate Filler and Discontinuous Fiber Filler Resin Composite's Adaptation and Bonding to Intra-Radicular Dentin

The aim of this study was to assess adaptation and bonding to root canal dentin of discontinuous (short) glass fiber-reinforced composite to intra-radicular dentin (DSGFRC).

METHODS

Seventy virgin human teeth were extracted and then endodontically treated; then samples were randomly divided into 7 groups (n = 10), based on the materials' combinations as follows: Group 1, a two-bottle universal adhesive + DSGFRC; Group 2, a single-component universal adhesive + DSGFRC; Groups 3 and 4, the same materials of Goups 1 and 2 were used but after cleaning of the canal walls with 17% EDTA and final irrigation with 5.25% NaOCl Ultrasound Activated (UA); Group 5, traditional prefabricated fiber posts were luted after being silanized with G-Multi Primer; Groups 6 and 7, like Group 5 but after ultrasonic irrigation (UA). All sample roots were cut 1 mm thick (n = 10) to be evaluated regarding root canal adaptation using a light microscope and scanning electron microscope (SEM) and push-out bond strength. These results were statistically analyzed by Kruskal-Wallis analysis of variance by ranks. The level of significance was set at p < 0.05.

RESULTS

Bond strength forces varied between 6.66 and 8.37 MPa and no statistically significant differences were recorded among the groups. By microscopic examination, it was noted that ultrasonic irrigation increased the adaptation of the materials to the dentin surface.

CONCLUSIONS

Within the limitations of this in vitro study, it may be concluded that when DSGFRC was used for intracanal anchorage in the post-endodontic reconstruction, similar push-out retentive force and strength to those of traditional fiber posts cemented with particulate filler resin composite cements were achieved.

Adhesion of individually formed fiber post adhesively luted with flowable short fiber composite

This laboratory study aimed to measure the push-out bond strength of individually formed fiber-reinforced composite (FRC) post luted with flowable short fiber-reinforced composite (SFRC) and to evaluate the influence of post coating with light-cured adhesive. Post spaces (Ø 1.7 mm) were drilled into 20 single-rooted decoronated premolar teeth. Post spaces were etched and treated with light-cured universal adhesive (G-Premio Bond). Individually formed FRC posts (Ø 1.5 mm, everStick) were luted either with light-cured SFRC (everX Flow) or conventional particulate-filled (PFC) dual-cure luting cement (G-CEM LinkForce). Half of the posts from each group were treated with dimethacrylate adhesive resin (Stick Resin) for 5 min before luting. After storage in water for two days, the roots were sectioned into 2 mm thick disks (n = 10/per group). Then, a push-out test-setup was used in a universal testing machine to measure the bond strength between post and dentin. The interface between post and SFRC was inspected using optical and scanning electron microscopy (SEM). Data were statistically analyzed using analysis of variance ANOVA (p = .05). Higher bond strength values (p < .05) were obtained when flowable SFRC was used as a post luting material. Resin coating of a post showed no significant effect (p > .05) on bond strength values. Light microscope images showed the ability of discontinuous short fibers in SFRC to penetrate into FRC posts. The use of flowable SFRC as luting material with individually formed FRC posts proved to be a promising method to improve the interface adhesion.

In Vitro Comparison of Fracture Resistance of Severely Damaged Primary Anterior Teeth Restored with Different Post and Core Systems

Objectives

This study aimed to compare the fracture resistance (FR) of severely damaged primary anterior teeth restored with five different post and core systems.

Materials and Methods

This in vitro, experimental study evaluated 60 extracted primary maxillary central incisors. The teeth were horizontally sectioned at 1 mm above their cementoenamel junction (CEJ), underwent pulpectomy, and their root canals were filled with Metapex paste. After post space preparation and sealing of root fillings with light-cure glass ionomer (1 mm thickness), the teeth were randomly assigned to five groups (n = 12) of (1) glass fiber post and everX composite (reinforced with short fibers), (2) glass fiber post and bulk-fill composite, (3) everX composite post and core, (4) bulk-fill composite post and core, and (5) Filtek conventional composite post and core. The teeth underwent 5,000 thermal cycles between 5°C and 55°C, and their FR was measured in a universal testing machine (0.5 mm/min, 148°). The mode of failure was also determined. Data were analyzed by ANOVA and Tukey's test at 0.05 level of significance.

Results

The FR was the highest in fiber post and everX composite, and the lowest in Z250 conventional composite post and core group (P < 0.001). The FR of fiber post and everX composite group was significantly higher than that of everX composite post and core (P = 0.04), bulk-fill composite post and core (P = 0.001), and Z250 composite post and core (P < 0.001) groups. The frequency of repairable fractures was the highest in glass fiber post plus everX composite (91.66%) and the lowest in Filtek conventional post and core group (66.66%) (P > 0.05).

Conclusion

Within the limitations of this in vitro study, the results showed that restoration of severely damaged primary maxillary central incisors with glass fiber post and everX composite reinforced with short fibers enhanced their FR, and increased the chance of reparability in case of restoration fracture. This technique may be recommended for the restoration of primary anterior teeth since it is simple and saves time.

The Use of Polyetheretherketone (PEEK) as an Alternative Post and Core Material: Five-Year Follow-Up Report

This clinical report demonstrated the use of polyetheretherketone (PEEK) for manufacturing of custom-made post and core in weakened endodontically treated central incisors. The PEEK structure was manufactured using computer-aided design/computer-aided manufacturing (CAD/CAM). The optimal fit of this custom-made endodontic post allowed a thinner cement layer; and removed the need to manufacture a core build-up. While supplementary clinical trials and in vitro studies are needed to totally elucidate the advantages and limitations of PEEK as an option for post and core manufacturing, this case report showed that it can be promising for a predictable and simplified treatment with five years of success.

High Performance Composites Based on Highly Filled Glass Fiber-Reinforced Polybenzoxazine for Post Application

Glass fiber post based on the new polymeric material, polybenzoxazine, is prepared and the effects of glass fiber contents on mechanical and thermal properties are evaluated. The mechanical response to externally applied loads of tooth restored with glass fiber-reinforced polybenzoxazine composite posts is also simulated by finite element analysis of a tridimensional model and compared with the response to that of a natural tooth. The reinforcing of glass fiber can help improve the mechanical and thermal properties of the polybenzoxazine influenced by the interfacial adhesion between the glass fiber and polybenzoxazine matrix, except for the relatively high mechanical property of the glass fiber. The mechanical data, i.e., elastic modulus under flexure load or flexural modulus by three-point bending test of the glass fiber-reinforced polybenzoxazine composites are agreed with the elastic modulus of dentin and then used in the finite element model. The restoration using the glass fiber-reinforced polybenzoxazine composite post provided the maximum von Mises equivalent stress at the cervical third area of the endodontically treated tooth model as similarly observed in the natural tooth. In addition, the maximum von Mises equivalent stress of the tooth restored with the glass fiber-reinforced polybenzoxazine composite post is also quietly like that of the natural tooth. The finding of this work provided the essential properties of the glass fiber-reinforced polybenzoxazine composite for dental restorations and appliances.

Influence of New Sleeve Composite on Fracture Behavior of Anterior Teeth with Flared Root Canals

We evaluated the fracture strength and failure mode of non-ferrule teeth with flared root canals that were restored using new experimental sleeve composites. Fifty endodontically treated anterior teeth with flared root canals were restored with direct restorations utilizing different techniques. Group A had teeth (non-ferrule) restored using commercialized MI glass fiber post + Gradia Core as core build-up. Group B had teeth (non-ferrule) restored with commercialized i-TFC glass fiber post + sleeve system. In Group C, the teeth (non-ferrule) were restored with an experimental sleeve composite with commercialized MI glass fiber post and Gradia Core. Group D, teeth (non-ferrule), were restored using custom-made tapered E-glass filling post and Gradia Core. Group E, teeth (with ferrule), were restored with commercialized MI glass fiber post + Gradia Core. After core construction, all specimens underwent direct composite crown restoration and were loaded until fracture using a universal testing machine. Average fracture loads were compared, and the failure modes were observed. Group C exhibited significantly greater fracture strength than other groups (p < 0.05). Favorable fracture teeth ratio of group C was more than that of the other groups. Thus, the new experimental sleeve composite could be clinically useful for core construction of non-ferrule teeth.

Fracture Resistance of Anterior Crowns Reinforced by Short-Fiber Composite

The aim of this study was to investigate the load-bearing capacity of anterior crowns made of different commercial particulate-filled composites (PFCs) and reinforced by a core of short-fiber composite (SFC) (bilayer structure). Four groups of composite crowns were fabricated for an upper central incisor (n = 20/group). Two groups were made of chair-side PFC composites (G-aenial anterior, GC, Japan and Denfil, Vericom, Korea) with or without SFC-core (everX Flow, GC). One group was made of laboratory PFC composite (Gradia Plus, GC) with or without SFC-core. The last group was made of plain SFC composite polymerized with a hand-light curing unit only or further polymerized in a light-curing oven. Using a universal-testing device, crown restorations were statically loaded until they fractured, and failure modes were visually investigated. Analysis of variance (p = 0.05) was used to evaluate the data, followed by Tukey’s post hoc test. Bilayer structure crowns with SFC-core and surface PFC gave superior load-bearing capacity values compared to those made of monolayer PFC composites; however, significant differences (p < 0.05) were found in the chair-side composite groups. Additional polymerization has no impact on the load-bearing capacity values of SFC crowns. Using SFC as a core material with PFC veneering composite to strengthen anterior crown restorations proved to be a promising strategy for further testing.

Stress distribution in restorations with glass fiber and polyetheretherketone intraradicular posts: An in silico analysis

This study evaluated stresses generated at maxillary central incisor (21) root restored with lithium disilicate crown (LDC), and glass fiber (GFP) or polyetheretherketone (PEEK) post. 3D models created by computed tomographic image (i-CAT Cone Beam 3D Dental Imaging System) reproduced maxillary central incisor. Each model had prosthetic LDCs (2.0 mm thick) cemented to GFP or PEEK posts with dual resin cement. Different loads were applied to each model (cervical, incisal, axial, middle). At maximum principal stress, PEEK showed higher stress than GFP in all loads, but with qualitative similarity. At minimum principal stress, PEEK and GFP showed qualitative and quantitative similarities, except axial load. Maxillary central incisor restored with GFP or PEEK and LDC presented, in general, similar stress intensity and distribution for main occlusal loads. Only two of sixteen occlusal loads tested (cervical for maximum principal; axial for minimum principal) showed significant quantitative difference.

Fatigue performance of endodontically treated premolars restored with direct and indirect cuspal coverage restorations utilizing fiber-reinforced cores

Objectives

The aim of this in vitro study was to investigate the fatigue survival and fracture behavior of endodontically treated (ET) premolars restored with different types of post-core and cuspal coverage restorations.

Materials and methods

MOD cavities were prepared on 108 extracted maxillary premolars. During the endodontic treatment, all teeth were instrumented with rotary files (ProTaper Universal) to the same apical enlargement (F2) and were obturated with a matched single cone obturation. After the endodontic procedure, the cavities were restored with different post-core and overlay restorations (n = 12/group). Three groups (A1–A3) were restored with either conventional composite core (PFC; control) or flowable short-fiber-reinforced composite (SFRC) core with/without custom-made fiber posts and without overlays. Six groups had similar post-core foundations as described above but with either direct PFC (B1–B3) or indirect CAD/CAM (C1–C3) overlays. Fatigue survival was tested for all restorations using a cyclic loading machine until fracture occurred or 50,000 cycles were completed. Kaplan-Meyer survival analysis was conducted, followed by pairwise post hoc comparisons.

Results

None of the restored teeth survived all 50,000. Application of flowable SFRC as luting-core material with fiber post and CAD/CAD overlays (Group C3) showed superior performance regarding fatigue survival (p < 0.05) to all the other groups. Flowable SFRC with fiber post and direct overlay (Group B3) showed superior survival compared to all other direct techniques (p < 0.05), except for the same post-core foundation but without cuspal coverage (Group A3).

Conclusions

Custom-made fiber post and SFRC as post luting core material with or without cuspal coverage performed well in terms of fatigue resistance and survival when used for the restoration of ET premolars.

Clinical relevance

The fatigue survival of direct and indirect cuspal coverage restorations in ET MOD premolars is highly dependent on whether the core build-up is fiber-reinforced or not. The combination of short and long fibers in the form of individualized post-cores seems to offer a favorable solution in this situation.

Fabricated CAD/CAM Post-Core Using Glass Fiber-Reinforced Resin Shows Innovative Potential in Restoring Pulpless Teeth

The prevention of root fractures of pulpless teeth is an important clinical issue to maintain healthy teeth through lifetime. The aim of this study was to examine a clinically effective treatment method for strengthening vulnerable pulpless teeth using CAD/CAM (computer-aided design/computer-aided manufacturing) fiber-reinforced post-core by conducting a fracture resistance test. A post-core made with a fiber-reinforced resin disk TRINIA (TR, SHOFU, Kyoto, Japan) was fabricated using a CAD/CAM system. The fiber-layer orientation of the CAD/CAM post-core was parallel to the axis of the restored tooth. A post-core using a conventional composite and a fiber post (CF) was also prepared. A fracture resistance test of teeth restored with the post-cores and zirconia crowns was conducted using a universal testing machine, and fracture patterns were identified by micro-CT observation. The fracture load of the roots restored with TR was 1555.9 ± 231.8 N, whereas that of CF was 1082.1 ± 226.7 N. The fracture load of TR was 43.8% that was significantly higher than that of CF (Student's t-test, p < 0.05). The restored teeth with CAD/CAM resin post-core were found to be repairable even after fracture. These results suggest that the CAD/CAM indirect fiber post-core has the potential to strengthen the vulnerable pulpless teeth.

Characterization of Experimental Short-Fiber-Reinforced Dual-Cure Core Build-Up Resin Composites

As a core build-up material, dual-cured (DC) resin-based composites are becoming popular. The aim of this research was to investigate specific physical and handling properties of new experimental short-fiber-reinforced DC resin composites (SFRCs) in comparison to different commercial, conventional DC materials (e.g., Gradia Core, Rebilda DC, LuxaCore Z, and Visalys^® CemCore). Degree of monomer conversion (DC%) was determined by FTIR-spectrometry using either self- or light-curing mode. The flexural strength, modulus, and fracture toughness were calculated through a three-point bending setup. Viscosity was analyzed at room (22 °C) and mouth (35 °C) temperatures with a rotating disk rheometer. The surface microstructure of each resin composite was examined with scanning electron microscopy (SEM). Data were statistically analyzed with analysis of variance ANOVA (p = 0.05). The curing mode showed significant (p < 0.05) effect on the DC% and flexural properties of tested DC resin composites and differences were material dependent. SFRC exhibited the highest fracture toughness (2.3 MPa m^1/2) values and LuxaCore showed the lowest values (1 MPa m^1/2) among the tested materials (p < 0.05). After light curing, Gradia Core and SFRCs showed the highest flexural properties (p < 0.05), while the other resin composites had comparable values. The novel DC short-fiber-reinforced core build-up resin composite demonstrated super fracture toughness compared to the tested DC conventional resin composites.

Effect of Composite Core Materials on Fracture Resistance of Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Various material properties are involved in the success of endodontically treated restorations. At present, restorative composites are commonly employed as core build-up materials. This study aimed to systematically review the literature to assess the effect of using composite core materials on the in vitro fracture of endodontically treated teeth. Two different reviewers screened the literature, up to June 2021, in five distinct electronic databases: PubMed (MedLine), Scopus, Scielo, ISI Web of Science, and EMBASE. Only in vitro studies reporting the effect of the use of composite core materials on the fracture resistance of endodontically treated teeth were included. A meta-analysis was carried out using a software program (Review Manager v5.4.1; The Cochrane Collaboration, Copenhagen, Denmark). The risk of bias in each study was assessed following the parameters of another systematic review. A total of 5016 relevant papers were retrieved from all databases. After assessing the title and abstract, five publications remained for qualitative analysis. From these, only three studies remained for meta-analysis. The fracture strength of endodontically treated teeth where a core build-up composite was used was statistically significantly higher than the control (p = 0.04). Most of the analyses showed a high heterogenicity. The in vitro evidence suggests that the composite core build-up with higher filler content tended to improve the fracture resistance of the endodontically treated teeth, in comparison with conventional composite resins. This research received no external funding. Considering that this systematic review was only carried out on in vitro papers, registration was not performed. Furthermore, there were no identified clinical studies assessing core build-up materials; therefore, more well-designed research on these materials is needed.