SYSTEMATIC REVIEW OF RESTORATION TECHNIQUES FOLLOWING ROOT CANAL THERAPY: SUCCESS RATES AND PATIENT SATISFACTION

Abstract

Background: The quality and type of the subsequent coronal restoration is a factor that determines the long-term success of root canal therapy in addition to the effectiveness of an endodontic treatment. Poorly restored endodontically treated teeth are structurally weak and prone to fracture, microleakage and restorative failure. Despite several post-endodontic restoration methods being suggested (such as direct restorations, full-coverage crowns, post-and-core systems, and endocrowns), there is still a controversy about which method (or a combination of them) would help to ensure maximum survival of the tooth and patient satisfaction. The aim of this systematic review was to compare and contrast the clinical success rates and patient-reported outcomes of the various restoration methods after root canal therapy.

Methodology: Systematic literature search was performed in the large electronic databases such as PubMed, Scopus and Google scholar and included studies published between 2000 and 2026. The criteria of eligibility were randomized controlled trials and post-endodontic restoration techniques in permanent teeth clinical observational studies. They were systematic reviews, narrative reviews, meta-analyses, abstracts of conferences, animal research, and in vitro research. Data were extracted based on the characteristics of the study, patient demographics, restorative interventions, follow-up period, survival rates, failure rates, and patient satisfaction scales. Cochrane Risk of Bias tool of randomized trials and Newcastle-Ottawa Scale of non-randomized studies were used to assess risk of bias.

Results: Over twenty clinical studies were incorporated in the qualitative synthesis. Full-coverage restorations, especially crowns, were found to have a better survival rate than direct restorations, especially in the posterior teeth that had a large coronal loss. Posts use was not associated with better tooth survival, but was useful in core retention in structurally compromised teeth. Fiber posts were linked to more desirable and restorative failure modes than metal posts. There was no difference in the survival rates of endocrowns and conventional post-and-core crowns in posterior teeth in medium-term follow-up. When reported, patient satisfaction outcomes were better with restorations that offered better esthetics, functional stability and retention. The included studies exhibited heterogeneity in the design of the study and reporting of outcomes.

Conclusion: The results show that the success of endodontically treated teeth is highly dependent on the type of post-endodontic restoration. Full-coverage restorations are the most predictable restorations in the posterior teeth, whereas conservative restorations like endocrowns have promising results in few cases. The use of posts should be discriminating, and they should be applied to retain not to reinforce. The use of patient-reported outcomes and clinical survival measures could increase the effectiveness of restorative decision-making and long-term treatment outcomes. More high quality randomized controlled studies that have standardized outcomes measures should be encouraged.