Journal of Dentistry 96 (2020) 103334

Contents lists available at ScienceDirect

Journal of Dentistry
journal homepage: www.elsevier.com/locate/jdent

Randomized controlled trial comparing glass fiber posts and cast metal posts T
a,b b b
Rafael Sarkis-Onofre , Helena Amaral Pinheiro , Victório Poletto-Neto ,
César Dalmolin Bergolib, Maximiliano Sérgio Cencib, Tatiana Pereira-Cencib,*
a
Graduate Program in Dentistry, Meridional Faculty (IMED), 304 Senador Pinheiro Machado Street, 99070-220, Passo Fundo, Brazil
b
Graduate Program in Dentistry, Federal University of Pelotas, 457 Gonçalves Chaves Street, Pelotas, Brazil

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: This study aimed to assess the survival and success of glass fiber posts compared to cast metal posts in
Clinical studies/trials teeth without ferrule.
Evidence-based dentistry/health care Material and Methods: An equivalency, prospective, double-blind (patient and outcome evaluator) randomized
restorative dentistry controlled trial (RCT) with parallel groups was designed to compare the clinical performance of cast metal and
Endodontics
glass fiber posts cemented in endodontically treated teeth without ferrule (NCT01461239). Teeth were randomly
allocated to the glass fiber or cast-metal post groups. All teeth were restored with single metal-ceramic crowns.
Kaplan-Meier analysis with the log-rank test was used to test the success and survival between glass fiber and
cast metal posts considering a cut-off value of P = 0.05. The annual failure rates were calculated considering the
survival data for all restorations and separated by type of post after five years.
Results: A hundred and nineteen patients and 183 posts (72 cast metal posts and 111 glass fiber posts) were
analyzed. The median follow-up was 62 months (IQR 37–81). The log-rank test for success (P = 0.26) and
survival (P = 0.63) analyses did not present statistically significant differences. The AFR of both posts after 5
years was 1.5%. Considering the posts separately and after 5 years, cast metal posts presented AFR of 1.2% and
glass fiber posts AFR of 1.7%. Most failures were in posterior teeth (16/23), 10 failures were classified as root
fractures and 5 as post debonding. The follow-up rate was 95.3%.
Conclusions: Glass fiber and cast metal posts showed good and similar clinical performance.
Clinical Significance: Results of this randomized controlled trial can help dentists to answer how the best tech-
nique to rehabilitate endodontically treated teeth with no remaining coronal wall.

1. Introduction
Considering the rehabilitation of endodontically treated teeth
(ETT), the absence of residual coronal walls is the worst-case scenario
to restore these teeth, and the use of intraradicular post is necessary as
the main method for retaining coronal restorative material [1–3].
Traditionally, posts can be classified based on the elastic modulus, with
metallic posts (prefabricated or cast metal posts), ceramic posts and
carbon fiber posts presenting high values and glass fiber posts pre-
senting low elastic modulus whilst it may be assumed that ETT restored
with these different types of posts present distinct mechanical behaviors
[4–6].
Few well-designed randomized controlled trials compared the use of
different types of posts considering the elastic modulus to restore teeth
with the absence of coronal walls [7,8], which may be failure-related. A
recent systematic review showed that there is still a lack of studies
comparing cast metal and glass fiber posts with longer follow-ups [3]
but suggests that metal posts would perform better in teeth without
ferrule. However, the overall literature is inconclusive regarding the
potential differences between these types of posts. Another important
aspect is the comparison between the failure rate of anterior and pos-
terior endodontically treated teeth. A recent systematic review sug-
gested that tooth position does not influence the failure rate; however,
the authors highlighted that the findings are based on short and
medium-term follow-up, and studies with longer follow-up time are
necessary [9].
Studies with a reasonable time of follow-up are relevant, especially
to have restorative treatments with more predictability as some mate-
rials might present late failures (on average considered after five years
of follow-up). Also, modern materials are developed to have satisfac-
tory performance after 2–3 years, and studies with less than that time of
follow-up present limited clinical relevance [10,11]. Thus, this study
aimed to test whether glass fiber posts present similar clinical perfor-
mance of cast metal posts in teeth without ferrule after up to 9 years of

⁎
Corresponding author at: Graduate Program in Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Room 519, Pelotas, 96015560, Brazil.
E-mail address: Tatiana.cenci@ufpel.tche.br (T. Pereira-Cenci).

https://doi.org/10.1016/j.jdent.2020.103334
Received 28 February 2020; Received in revised form 30 March 2020; Accepted 8 April 2020
0300-5712/ © 2020 Elsevier Ltd. All rights reserved.
R. Sarkis-Onofre, et al.
follow-up.
2. Materials and methods
2.1. Experimental design
This study was an equivalency, prospective, double-blind (patient
and evaluator), randomized controlled trial (RCT) with parallel groups
designed to compare the clinical performance of cast metal and glass
fiber posts. The study was registered at ClinicaTrials.gov
(NCT01461239) and approved by the Local Research and Ethics
Committee (Protocol 122/2009). The reporting of the study is based on
the CONSORT statement [12]. The study took place in a University and
is, in part, a follow-up of another study [13], which reported on partial
results of the first cohort of included patients. First, the oral health of
the participants was assessed, and all participants signed written in-
formed consent before being accepted into the study. Patients who met
the following inclusion criteria were included: participants with good
oral health (no caries lesion, no periodontal disease) that had anterior
or posterior endodontically treated teeth without coronal walls or 1
wall in enamel without dentine support (with a ferrule height of 0 to
0.5 mm) that needed use of intraradicular post (with glass fiber or cast
metal post, according to the randomization) and a single crown. The
participants should have bilateral occlusal posterior contacts. Exclusion
criteria were endodontically treated teeth with periodontal or occlusal
problems and large prostheses (Kennedy Class I or II) antagonist to the
tooth to be restored. The participants were recalled after six months,
and annually until nine years for clinical and radiographic examination.
The primary outcome was post loss; however, all reasons for failure
were considered in the analyses (success).
2.2. Sample size calculation
Considering that most studies have shown no difference in survival
between post types [7,8,14,15], the sample size calculation was per-
formed based on the equivalence of treatments. Under the assumption
of no difference between standard and experimental treatments, this
calculation determined that 64 participants (teeth) were required to be
90% sure that the limits of a two-sided 90% confidence interval would
exclude a difference of more than 18% between the standard and ex-
perimental treatment groups.
2.3. Randomization procedures
All teeth were randomized and assigned to each group using a
computer-generated list of random numbers. Each number was written
on a white paper and placed into plain brown envelopes by a researcher
not involved in the study based on the list of random numbers.
Allocation only occurred after filling removal. The randomization was
to post-selection (glass fiber or cast metal post). The randomization was
stratified by tooth type/location, anterior, premolar or molar with a 1:1
allocation using random block sizes of 6 and 8.
2.4. Clinical procedures
Materials and procedures used for root canal treatment and all re-
storative procedures were reported in detail elsewhere [13]. Briefly, all
teeth included in the study received endodontic treatment using the
crown down technique, irrigated with 2.5% NaOCl solution and filled
by lateral condensation technique using Grossman Cement (Endo-fill,
Dentsply/Maillefer, Petrópolis, Brazil) and gutta-percha cones
(Dentsply/Maillefer, Petrópolis, Brazil).
Glass fiber posts (White Post DC; FGM, Joinville, Brazil) were luted
with regular or self-adhesive resin cement (RelyX ARC or U100/200,
3 M, ESPE, St Paul, USA). The resin cement was applied into the root
canal using a Centrix syringe (DFL Indústria e Comércio S.A., Rio de
2
Journal of Dentistry 96 (2020) 103334
Janeiro, Brazil), and the core was made with composite resin
(ScotchBond Multi-Purpose and Z250, 3 M, ESPE). Considering molars
and premolars with more than one root canal, only one glass fiber post
was used in the larger root canal. Cast metal posts were luted using self-
adhesive resin cement (RelyX U100 or U200, 3 M, ESPE). After post
cementation, radiographs were taken to check the success of the pro-
cedure.
All teeth received as final restoration a single metal-ceramic crown
also cemented with self-adhesive cement. All procedures were carried
out by undergraduate and graduate students that attended 12 h of
lectures in restorative dentistry and training on the subject.
2.5. Evaluation parameters
Post cementation time was considered as baseline. All participants
were recalled after six months and annually up to 9 years for clinical
and periapical radiographic examination. As patients' intake occurred
during a broad timespan, follow-up time varied. Two examiners were
calibrated to perform the evaluations for FDI criteria, with no need for
the primary outcome assessment calibration as this was post debonding.
The crown evaluation was performed according to the FDI criteria
[3,16] by one of the two calibrated examiners. Initially, a blind ex-
aminer (to the type of post) performed the crown evaluation, and an-
other person without involvement in the study performed the radio-
graphic exam. Only after the initial evaluation of the crown, the
radiographic exam was evaluated. This sequence of the evaluation was
chosen to assure the blind clinical evaluation. Periodontal status
(probing depth and clinical attachment level), pain occurrence, an-
tagonist status, and occlusion pattern were evaluated. The occurrence
of the following events was recorded:
• Secondary caries: the presence of caries adjacent to restorations
• Endodontic failure: radiographic signs of apical periodontitis, clin-
ical signs and/or symptoms of tenderness to percussion or presence
of periapical abscess draining through a fistula.
• Crown fracture: material chip fractures that damage the marginal
quality or proximal contacts and bulk fractures with partial loss (less
than half of the restoration).
• Post fracture: all levels of post fracture were considered, irrespective
of its position on the arch or extension.
• Crown dislodgement: characterized as the total loss of crown or
partial loss that allows dislodgment using a manual instrument.
• Post debonding: characterized as the total loss of post or post and
crown or partial loss that allows dislodgment using a manual in-
strument.
• Root fracture: root fractures leading to tooth extraction and partial
root fractures that could be treated with all types of surgical crown
lengthening.
The occurrence of failures was categorized in absolute or relative
failure. Failures resulting in tooth extraction were considered absolute
failure, and post debonding with the possibility of recementation was
considered a relative failure. If the patient returned to the exam with a
tooth without the post, the time of failure was based on patient self-
report of when the post debonded. Success was defined as the absence
of absolute and relative failures, and survival was defined as the ab-
sence of absolute failures.
2.6. Statistical analysis
Statistical analysis was performed using Stata 14.0 software
(StataCorp, College Station, USA). Descriptive analyses were used to
describe the participants (teeth) included in the study and the reasons
for failure. Kaplan-Meier analysis with the log-rank test was used to test
the success and survival between glass fiber posts and cast metal posts
considering a cut-off value of P = 0.05. In cases of patients who failed
R. Sarkis-Onofre, et al. Journal of Dentistry 96 (2020) 103334

to attend the latest study visit, the last observed value forward was used Table 1
for any parameter, including time in service. Adjusted Cox regression Patient and teeth characteristics.
models with shared frailty for patients were used considering the sur- N %
vival data to verify the association between the posts used, tooth po-
sition (anterior and posterior) and arch (maxilla and mandible) and the Gender Female 96 80.7%
risk of failure calculating the Hazard Ratio (HR) and 95% confidence
Male 23 19.3%
intervals. The annual failure rates (AFR) of the restorations were cal-
culated according to the formula: (1-y)z = (1-x), in which 'y' expresses Age - years Mean 45.1 (SD
the mean AFR and 'x' the total failure rate at 'z' years considering the 11.8)
survival data for all restorations and separated by type of post and tooth
Teeth characteristics Cast metal posts Glass fiber posts Total n/%
location (anterior vs. posterior) after 5 years (median of follow-up). The
n/% n/%
principle of per-protocol analysis was used in all analyses, and a 95% Number of teeth 72 39.3% 111 60.6% 183
confidence interval (95% CI) was considered. As an additional analysis, Dental group
the log-rank test was used to test the success and survival between glass Maxillary Incisor 36 19.7% 39 21.3% 75 41%
fiber posts and cast metal posts considering a cut-off value of P = 0.05 Maxillary Canine 4 2.2% 2 1.1% 6 3.3%
Maxillary Premolar 10 5.5% 32 17.5% 42 23%
and only restorations followed for a minimum five years Maxillary Molar 6 3.3% 10 5.5% 16 8.7%
(Supplementary Material). Mandibular Incisor 4 2.2% 2 1.1% 6 3.3%
Mandibular Canine 2 1.1% 1 0.5% 3 1.6%
Mandibular Premolar 5 2.7% 16 8.7% 21 11.4%
3. Results
Mandibular Molar 5 2.7% 9 4.9% 14 7.6%
Median of follow-up 67.5 (41-81) 58 (35-81) 62 (37-81)
All procedures were performed between July 2009 and October (IQR)*
2016. Fig. 1 presents the participants' flow diagram. After up to 9 years
of follow-up, 119 patients and 111 glass fiber posts and 72 cast metal *time in months; SD=standard deviation.
posts were analyzed. The number of glass fiber posts was higher be-
cause three trials were being conducted at the same time, as previously were male, and 96 (80.7%) were female. The mean age was 45.1 (SD
reported [13,17,18]. Table 1 presents the characteristics of patients and 11.8). Most posts were performed in upper incisors (n = 75). The
teeth included in the analysis. A hundred and nineteen patients and 183 median follow-up was 62 months (IQR 37–81), with a minimum follow-
teeth were included in the analysis. Twenty-three patients (19.3%) up time of 12 months.

Fig. 1. Flowchart of trial phases.

3
R. Sarkis-Onofre, et al. Journal of Dentistry 96 (2020) 103334

Fig. 2. A) Kaplan-Meier estimates considering the absence of absolute and relative failures (success). B) Kaplan-Meier estimates considering the absence of absolute
failures (survival).

4
R. Sarkis-Onofre, et al. Journal of Dentistry 96 (2020) 103334

Table 2 distinct mechanical behaviors, but after up to 9 years, both posts pre-
Adjusted and Hazard Ratios (HR: 95% CI) for tooth survival. Cox Regression sented similar clinical performance. These results are important be-
Analysis. cause a recent systematic review [3] highlighted that studies assessing
Variables HR (95%CI) P-value the clinical performance of posts with high elastic modulus present
Post longer follow-up than studies assessing glass fiber posts. Also, studies
comparing the clinical performance of both posts with extended follow-
Cast metal post 1
up are still necessarily justifying the importance of this study.
Glass fiber post 0.84 (0.2; 3.7) 0.82
Position A recent meta-analysis [19] showed a positive effect of the presence
Anterior 1 of ferrule in the survival of ETT, especially in premolars demonstrating
Posterior 5.3 (0.9; 31.0) 0.06 that the absence of ferrule and coronal walls is the worst-case scenario
Arch
to restore ETT. Given the availability of several treatment options, a
Maxilla 1
Mandible 1.3 (0.3; 6.0) 0.7
variety of posts, and other materials to restore the coronal portions of
these teeth, we can consider the use of glass fiber posts or cast metal
posts associated with single crowns as good options to restore ETT with
Kaplan-Meier graphs considering the success and survival of re- the absence of residual coronal walls. Considering the AFRs after five
storations are presented in Fig. 2. The log-rank test for both analyses did years, the estimates ranged between 1.2 and 1.7%. Demarco et al. 2012
not present statistically significant differences (success: P = 0.26 and demonstrated that AFRs of posterior composite restorations placed in
survival: P = 0.63, respectively). Table 2 presents the adjusted Cox vital teeth could vary between 1% and 3% while for ETT, the AFRs vary
regression models, and all variables tested were not statistically sig- from 2% to 12.4% [20]. Naumann et al., 2012 observed the AFRs of
nificant. The AFR of both posts after five years was 1.5%. Cast metal 4.6% after an up to 10 years of follow-up, considering only glass fiber
posts presented AFR of 1.2% and glass fiber posts AFR of 1.7% after five posts [21]. We believe that our average AFR was low because the study
years. Anterior teeth presented AFR of 0.5% and posterior teeth AFR of was conducted in a controlled environment, and all procedures were
2.5%. carried out by students that received training on the subject, and that
Table 3 presents the characteristics of each failure. Twenty-three worked under the direct supervision of experienced clinicians.
failures were observed, including seventeen failures associated with Twenty-three failures were observed in the trial, especially asso-
glass fiber posts and six associated with cast metal posts. Most failures ciated with root fracture (10/23). The literature has been discussing the
were in posterior teeth (16/23); ten failures were classified as root incidence rate of root fracture, considering posts with different elastic
fractures (7 Glass fiber post and 3 Cast metal post). Considering the modulus. The findings of Figueiredo et al., 2015 demonstrated a similar
primary outcome (post debonding), only five failures were observed (3 incidence of root fracture comparing metal and fiber posts and do not
Glass fiber post and 2 Cast metal post). Considering the FDI criteria, all support the use of glass fiber posts based on the possible reduction of
crowns were classified as score 1 or 2. Seven teeth were lost during root fracture [22]. Our results showed ten failures characterized as root
follow-up in the cast metal post group with patients declining to par- fracture with seven associated with glass fiber posts and could be re-
ticipate, and two teeth were lost in the glass fiber posts due to the lated to unobserved root defects. Another important aspect related to
patient's allergy to metal and change in planned treatment. the failures is that most failures occurred in posterior teeth. Garcia
et al., 2019 showed that the failure rate of anterior and posterior teeth
4. Discussion restored with the post-and-core restoration was similar. However, they
highlighted that some studies reported a higher incidence of failures in
This RCT is the first study to present a comparison between the use posterior teeth related to teeth without remaining coronal walls [9].
of glass fiber posts and cast metal posts only considering teeth without Also, 60% of failures were observed in premolars, including seven root
remaining coronal walls after up to 9 years of follow-up. It could be fractures. The association of two aspects could explain this result: 1)
expected that ETT restored with these different types of posts present only teeth with the absence of ferule were included in this trial 2) the

Table 3
Characteristics of each failure observed in the study.
Tooth number Type of Post Time of failure (in months) Failure reason

25 Glass fiber post 92 Crown debonding

11 Glass fiber post 30 Root fracture
25 Glass fiber post 27 Root fracture
26 Cast metal post 19 Root fracture
44 Glass fiber post 37 Root fracture
45 Glass fiber post 36 Post debonding
35 Glass fiber post 87 Crown and post debonding
44 Glass fiber post 18 Root fracture
11 Glass fiber post 1 Post debonding
15 Glass fiber post 49 Crown debonding
24 Cast metal post 13 Post debonding
45 Glass fiber post 86 Crown debonding
24 Glass fiber post 31 Root fracture
23 Cast metal post 81 Crown debonding
32 Cast metal post 36 Root fracture
11 Glass fiber post 96 Crown debonding
31 Cast metal post 40 Crown and post debonding
21 Glass fiber post 103 Endodontic failure
24 Glass fiber post 23 Root fracture
24 Glass fiber post 46 Root fracture
34 Cast metal post 16 Root fracture
24 Glass fiber post 15 Secondary caries
45 Glass fiber post 51 Crown debonding

5
R. Sarkis-Onofre, et al.
results of Skupien et al., 2016 showed in a recent systematic review the
effect of the ferrule in the survival of ETT especially in premolars [19].
This RCT was conducted based on the assumed equivalence of the
interventions. It aimed to demonstrate that the new intervention (glass
fiber posts) is similar, in terms of the primary outcome than the stan-
dard (cast metal posts) using a predefined margin [23]. This approach
was used because the majority of clinical studies have not produced
results favoring any particular post available in the market. One im-
portant limitation of the trial is that part of the restorations presented
observation time lower than five years of follow-up considering both
groups, and more time of follow-up is always necessary. Nevertheless,
an essential finding of this study was that no failure occurred after 3.7
years, while 94 cases (of the 183) presented more than five years of
follow-up. The results of this trial can help dentists to answer how is the
best post system to rehabilitate ETT with the absence of coronal walls.
Based on our results, dentists can consider glass fiber and cast metal
posts luted with resin cement associated with single crowns a good
option to restore these ETT.
5. Conclusion
After up to 9 years of follow up, glass fiber and cast metal posts
showed good and similar clinical performance. However, more studies
and longer follow-up times are needed to confirm the similarity of post
systems over time.
CRediT authorship contribution statement
Rafael Sarkis-Onofre: Investigation, Formal analysis, Writing -
original draft. Helena Amaral Pinheiro: Investigation, Writing - re-
view & editing. Victório Poletto-Neto: Investigation, Writing - review
& editing. César Dalmolin Bergoli: Investigation, Writing - review &
editing. Maximiliano Sérgio Cenci: Conceptualization, Methodology,
Supervision, Writing - review & editing. Tatiana Pereira-Cenci:
Conceptualization, Methodology, Project administration, Writing - re-
view & editing.
Declaration of Competing Interest
The authors deny any conflicts of interest related to this study
Acknowledgements
RSO is funded in part by Meridional Foundation (Passo Fundo –
Brazil). TPC and MSC are partially funded by the National Council for
Scientific and Technological Development (CNPq - Brazil). This study
was conducted in a Graduate Program supported by CAPES, Brazil. The
funders had no role in the study design, data collection, and analysis,
decision to publish or preparation of the manuscript. All authors gave
their final approval and agree to be accountable for all aspects of the
work. We declare that the research is free of conflict of interest.
Appendix A. Supplementary data
Supplementary material related to this article can be found, in the
online version, at doi:https://doi.org/10.1016/j.jdent.2020.103334.
Journal of Dentistry 96 (2020) 103334
References
[1] A.S. Fernandes, S. Shetty, I. Coutinho, Factors determining post selection: a lit-
erature review, J. Prosthet. Dent. 90 (2003) 556–562.
[2] C. Goracci, M. Ferrari, Current perspectives on post systems: a literature review,
Aust. Dent. J. 56 (2011) 77–83.
[3] R. Sarkis-Onofre, D. Fergusson, M.S. Cenci, D. Moher, T. Pereira-Cenci, Performance
of post-retained single crowns: a systematic review of related risk factors, J. Endod.
43 (2017) 175–183.
[4] N.Z. Baba, C.J. Goodacre, T. Daher, Restoration of endodontically treated teeth: the
seven keys to success, Gen. Dent. 57 (2009) 596–603.
[5] C.J. Soares, A.D. Valdivia, G.R. da Silva, F.R. Santana, S. Menezes Mde,
Longitudinal clinical evaluation of post systems: a literature review, Braz. Dent. J.
23 (2012) 135–740.
[6] A. Torbjorner, B. Fransson, A literature review on the prosthetic treatment of
structurally compromised teeth, Int. J. Prosthodont. 17 (2004) 369–376.
[7] G. Sterzenbach, A. Franke, M. Naumann, Rigid versus flexible dentine-like en-
dodontic posts–clinical testing of a biomechanical concept: seven-year results of a
randomized controlled clinical pilot trial on endodontically treated abutment teeth
with severe hard tissue loss, J. Endod. 38 (2012) 1557–1563.
[8] F. Zicari, B. Van Meerbeek, E. Debels, E. Lesaffre, I. Naert, An up to 3-Year con-
trolled clinical trial comparing the outcome of glass Fiber posts and composite cores
with gold alloy-based posts and cores for the restoration of endodontically treated
teeth, Int. J. Prosthodont. 24 (2011) 363–372.
[9] P.P. Garcia, L.M. Wambier, J.L. de Geus, L.F. da Cunha, G.M. Correr, C.C. Gonzaga,
Do anterior and posterior teeth treated with post-and-core restorations have similar
failure rates? A systematic review and meta-analysis, J. Prosthet. Dent. 121 (2019)
887–894.
[10] N.J.M. Opdam, K. Collares, R. Hickel, S.C. Bayne, B.A. Loomans, M.S. Cenci,
C.D. Lynch, M.B. Correa, F. Demarco, F. Schwendicke, N.H.F. Wilson, Clinical
studies in restorative dentistry: new directions and new demands, Dent. Mater. 34
(2018) 1–12.
[11] F. Schwendicke, N. Opdam, Clinical studies in restorative dentistry: design, con-
duct, analysis, Dent. Mater. 34 (2018) 29–39.
[12] G. Piaggio, D.R. Elbourne, S.J. Pocock, S.J. Evans, D.G. Altman, C. Group, Reporting
of noninferiority and equivalence randomized trials: extension of the CONSORT
2010 statement, JAMA. 308 (2012) 2594–2604.
[13] R. Sarkis-Onofre, C. Jacinto Rde, N. Boscato, M.S. Cenci, T. Pereira-Cenci, Cast
metal vs. Glass fibre posts: a randomized controlled trial with up to 3 years of follow
up, J. Dent. 42 (2014) 582–587.
[14] M. Naumann, S. Reich, F.P. Nothdurft, F. Beuer, J.F. Schirrmeister, T. Dietrich,
Survival of glass fiber post restorations over 5 years, Am. J. Dent. 21 (2008)
267–272.
[15] M. Naumann, G. Sterzenbac, F. Alexandra, T. Dietrich, Randomized controlled
clinical pilot trial of titanium vs. Glass fiber prefabricated posts: preliminary results
after up to 3 years, Int. J. Prosthodont. 20 (2007) 499–503.
[16] R. Hickel, A. Peschke, M. Tyas, I. Mjor, S. Bayne, M. Peters, K.A. Hiller, R. Randall,
G. Vanherle, S.D. Heintze, FDI World Dental Federation: clinical criteria for the
evaluation of direct and indirect restorations-update and clinical examples, Clin.
Oral Investig. 14 (2010) 349–366.
[17] C.D. Bergoli, L.P. Brondani, V.F. Wandscher, G. Pereira, M.S. Cenci, T. Pereira-
Cenci, L.F. Valandro, A multicenter randomized double-blind controlled clinical
trial of Fiber post cementation strategies, Oper. Dent. 43 (2018) 128–135.
[18] J.A. Skupien, M.S. Cenci, N.J. Opdam, C.M. Kreulen, M.C. Huysmans, T. Pereira-
Cenci, Crown vs. Composite for post-retained restorations: a randomized clinical
trial, J. Dent. 48 (2016) 34–39.
[19] J.A. Skupien, M.S. Luz, T. Pereira-Cenci, Ferrule effect: a meta-analysis, J. Dent.
Res-CTR. 1 (2017) 31–39.
[20] F.F. Demarco, M.B. Correa, M.S. Cenci, R.R. Moraes, N.J. Opdam, Longevity of
posterior composite restorations: not only a matter of materials, Dent. Mater. 28
(2012) 87–101.
[21] M. Naumann, M. Koelpin, F. Beuer, H. Meyer-Lueckel, 10-year survival evaluation
for glass-fiber-supported postendodontic restoration: a prospective observational
clinical study, J. Endod. 38 (2012) 432–435.
[22] F.E. Figueiredo, P.R. Martins-Filho, E.S.A.L. Faria, Do metal post-retained restora-
tions result in more root fractures than fiber post-retained restorations? A sys-
tematic review and meta-analysis, J. Endod. 41 (2015) 309–316.
[23] F.C. Friedman, LM, D.L. DeMets, Fundamentals of Clinical Trials. Springer, New
York, 2010.