Longevity of metal-ceramic single crowns cemented with self-adhesive resin cement: An update of a prospective analysis with up to 106 months of follow-up

doi:10.21203/rs.3.rs-1734982/v1

Download PDF

Research Article

Longevity of metal-ceramic single crowns cemented with self-adhesive resin cement: An update of a prospective analysis with up to 106 months of follow-up

https://doi.org/10.21203/rs.3.rs-1734982/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Objectives: To evaluate longevity of metal-ceramic single crowns cemented using a self-adhesive resin cement in a prospective clinical analytical study.

Methods: A total of 152 teeth received resin composite prosthetic cores and metal-ceramic crowns cemented with a self-adhesive resin cement. The patients included in the sample were recalled for clinical and radiography evaluation in an up-to-106-month period after the final cementation procedures, with an average of 62 months of follow-up. Next, 93% of the sample (142 teeth) were evaluated regarding the treatment survival rate, analysed considering the loss of crown retention (crown debonding) as the primary outcome. In addition, post debonding, root fracture and tooth loss occurrences were also recorded as secondary outcomes to evaluate the success rate of the prosthetic treatment. The aesthetic parameters were also evaluated according to the FDI criteria. The Kaplan-Meier method and Cox regression, with 95% confidence interval was applied for the statistical analysis.

Results: Regarding the primary outcome, the metal-ceramic crowns cemented with self-adhesive resin cement presented a high survival rate (93%), with 8 crown debondings occurring after the evaluation period. For secondary outcomes, 9 root fractures, 4 post debondings and 3 tooth losses (1 due to caries and 2 due to periodontal disease) occurred, generating a success rate of 72%. All crowns had a score 1 on the FDI criteria, indicating that they were clinically excellent or very good regarding the aesthetic parameters.

Conclusion: The metal-ceramic crowns luted with a self-adhesive resin cement presented a survival rate of 93% after an average follow-up of 62 months. Furthermore, the restorations remained aesthetically satisfactory over time, without changes that would indicate prosthetic retreatment. A success rate of 72% was obtained considering the secondary outcome, mainly related to intraradicular retainer failures (root fractures or post debonding).

Clinical Significance: The self-adhesive resin cement is clinically indicated for cementation of metal-ceramic crowns.

bilayer crown

survival rate

success rate

self-adhesive resin cement

Although monolithic crowns (consisting of only one material) are becoming increasingly popular in the prosthetic restoration of teeth with extensive structural loss, conventional crowns made from a metallic infrastructure covered with ceramic continue being widely used due to extensive knowledge, mastery of the technique acquired over the years, good longevity and predictability [1]. These bilayer restorations are traditionally cemented using zinc phosphate cement triggering micromechanical retention through filling irregularities of the tooth surface and the inner surface of the cast metal infrastructure [2].

The limitation of zinc phosphate cement is the lack of adhesion to the tooth structure and the high solubility [2]. On the other hand, resin cements continue to scientifically evolve and innovate in mechanical and adhesive properties, becoming widely spread mainly due to predictability and lasting results when adhered to dental tissues [3, 4]. Among these resin cements, self-adhesive systems present the advantage of a simplified application technique, eliminating the clinical step of conditioning the tooth surface and/or the application of an adhesive system [5]. However, it is suggested that conventional resin cements (consisting of systems with pre-conditioning and application of adhesive) have superior bond strength to dentin [6], although these results are based on laboratory studies and therefore require caution when extrapolating to clinical conditions.

On the other hand, teeth submitted to restorations with prosthetic crowns were often endodontically treated and therefore require a root retainer due to the substantial loss of the coronary structure [7]. In this context, the use of fiberglass posts appears as a favorable alternative due to its similarity to root dentin and consequent lower stress concentration in the root compared to metallic cores [8, 9]. Thus, the prosthetic substrate such as dentin should be disregarded, predominantly becoming the resin composite used in the reconstruction of the prosthetic core [10].

Given the similarity of composition between the resin cement and resin composite of the prosthetic core, it is possible to predict an excellent bond strength at this interface, although the operative steps should be considered as possible modifiers of the adhesive surface of the core influencing the bond between these two materials [11]. Even so, the weak link of adhesive cementation of the bilayer crown with metallic infrastructure is still the interface between resin cement and metallic alloy. Although the use of metallic primers is the subject of research, its results seem to be of little relevance, with the roughness of the inner surface of the crown being the main agent for cementation with resin cement [12].

Given the above, studies with a long period of follow-up are needed to assess the clinical behavior of bilayer crowns with metallic infrastructure adhesively cemented with self-adhesive systems onto resin composite prosthetic cores. In a previous study, a sample of 152 metal-ceramic crowns were followed-up for a period of up to 72 months (6 years) [13]. Thus, the present study aimed to update the longevity of metal-ceramic single crowns cemented with self-adhesive resin cement by performing an up-to-106-month follow-up period prospective longitudinal study, with the hypothesis that crowns cemented with self-adhesive resin cement must have high survival and success rates, and therefore may be clinically indicated.

2.1. Study design, ethical aspects and sample description

This is a prospective clinical analytical study of metal-ceramic crowns from a sample of a randomized multicenter clinical trial (RCT) registered at ClinicalTrials.gov (NCT01461239) [14].

The sample of the previous study (randomized clinical trial) that gave rise to this prospective study consisted of 152 teeth in need of unitary fixed prosthesis, treated during the years 2009 to 2014 during which 129 patients were included to received metal-ceramic single crowns respecting the inclusion and exclusion criteria described in Table 1. The research was developed at two dental schools and approved by both of their ethical committees (protocols 099/2009 and 0170.1.243.000–09).

Table 1

Inclusion and exclusion criteria.
Level	Inclusion criteria	Exclusion criteria
Tooth	• Loss of coronary structure that would indicate the manufacture of a unitary fixed prosthesis; • Satisfactory endodontic treatment;	• Mobility greater than grade 1; • Presence of an apical lesion, which could not be eliminated with conventional endodontic treatment; • Abutted a fixed partial prosthesis or a removable partial denture.
Patient	• Good oral hygiene; • Absence of parafunctional • habits • Bilateral simultaneous posterior occlusal contacts.	• Advanced untreated periodontal disease • Systemic disease that interferes with bone quality

For the previous study, patients were randomized into two different fiberglass post cementation strategy groups (adhesively cemented with conventional adhesive cementation strategy or a self-adhesive resin cement strategy). After cementation of the glass fiber post and preparation of the prosthetic core, all received metal-ceramic crowns cemented with self-adhesive resin cement (RelyX U100/U200; 3M-ESPE, St. Paul, USA).

2.2. Operator’s Clinical Training

Before the experimental procedures, the researchers responsible for the study (C.D.B and T.P.C) trained the dentists who performed the experimental procedures. One-month hands-on training and lectures were used so that all procedures were standardised in the two centers. All procedures were carried out by senior year undergraduate students under the main researchers’ supervision.

2.3. Clinical Procedures

Eligible patients initially received a clinical dental examination, as well as periodontal and occlusion evaluations. Needs for dental treatment (periodontic and endodontic treatments) were performed prior to experimental procedures. After establishing the clinical health conditions of the patient, they were able to receive restorative procedures.

The endodontically treated teeth were x-rayed to determine the working length and the glass fiber post (White Post DC; FGM) diameter. The root canal was prepared with the system drill until two-thirds of its length, keeping at least 3 mm of apical sealing. The fiber post was tested, sectioned keeping 4-mm coronal length and cleaned with 70% alcohol. The posts received a silane coupling agent (ProSil, FGM) and then cemented with a conventional resin cement (RelyX ARC; 3M-ESPE) or self-adhesive cement (RelyX U100/U200; 3M-ESPE) following the resin cement manufacturer’s recommendation.

After the post cementation, the prosthetic core was built up with microhybrid composite resin (Filtek™ Z250™; 3M^® ESPE) and prepared with water-cooled diamond burs. The prosthetic cores were finished using FF diamond burs with hand-piece coupled to a low-speed motor. The teeth were impressed using polyether (Impregum; 3M-ESPE) and sent to the laboratory for metal-ceramic crown confection. In the meantime, the teeth received a temporary acrylic resin crown.

After adaptation tests and adjustments, the definitive metal-ceramic crowns were cemented with self-adhesive resin cement (RelyX U100/U200; 3M-ESPE). To do so, resin cement pastes were mixed and inserted to the inner surface of the crown. Then, the crown was positioned onto the prosthetic core and the excess was removed with dental floss and/or microbrushes. The crown was kept in position for five minutes and then the cement was light-cured for 40 seconds. Finally, a new radiograph was taken to serve as baseline data (initial evaluation). In addition, the patients underwent a clinical examination, where various information that could influence the results were noted, such as the number of remaining walls, tooth region in the arch, fiber post cementation length and type of antagonist.

2.4. Evaluation methods

Clinical evaluations were performed at annual intervals and consisted of clinical and radiographic evaluations of the elements that received the unitary fixed prostheses. The primary outcome assessed was the crown debonding and their results influenced the survival rates. The secondary outcomes evaluated were post debonding, root fracture and loss of the element due to periodontal or caries disease. The presence of these outcomes influenced the success rates. Patients who reported not being able to compare to the recall were interviewed by telephone about the situation of the dental element, and their reporting was recorded for the evaluation of the primary outcome. If the patient related the occurrence of one of these failures at the re-evaluation moment between the annual clinical evaluations period, the moment of the failure reported by the patient was considered to calculate the survival time.

In addition to the primary and secondary factors, the sample was evaluated for aesthetic parameters according to the FDI criteria, classifying surface gloss, surface and marginal coloration, color and translucency correspondence, and aesthetic anatomical shape in scores between 1 (clinically excellent/very good) and 5 (clinically poor/replacement necessary) [15].

All the clinical evaluations were performed during the year of 2018 in both centers. The evaluators underwent adequate training and calibration to perform the exams until reaching inter and intra-examiner kappa values greater than 0.8.

2.5. Statistical Analysis

The SPSS 22 program for MAC (SPSS Inc, Chicago, IL) was used for the statistical analysis. Descriptive analysis was performed to describe the sample characteristics. Longevity (survival and success rates) was also assessed using the Kaplan-Meier test. Cox regression was performed to assess possible predictor variables (α < 0.05).

This study included 117 patients (93% recall rate), 118 women and 24 men, with an overall mean age of 49 years at the time of data collection. In all, 142 crowns were evaluated, with 62 in the anterior region and 80 in the posterior region (Table 2). An average follow-up of 62 months was obtained regarding the period between the definitive crown cementation (baseline) and the assessment included in this study.

Table 2

Sample characteristics distribution according to patient sex, patient age group and tooth region.
Gender	Tooth region
Gender	anterior	posteriors	total
Female	51	67	118
19–39	4	10	14
40–59	40	47	87
60 >	7	10	17
Male	11	13	24
30–39	1	2	3
40–59	7	8	15
60 >	3	3	6
TOTAL	62	80	142

Regarding the primary outcome (crown debonding), 8 occurrences were registered in the evaluation period (Fig. 1). Thus, a survival rate of 93% was obtained in the period of up to 106 months of follow-up (Fig. 2). The evaluation of possible predictor variables (number of remaining walls, tooth region in the arch, cementation length and type of antagonist) did not present relevant data that could be classified.

A success rate (obtained through the secondary outcomes) of 72% was obtained (Fig. 3), considering the occurrence of nine root fractures, three tooth losses (1 due to caries and 2 due to periodontal disease) and four post debondings (Fig. 1).

All of the 134 crowns in function at the time of reassessment received a score of 1 regarding the aesthetic parameters according to the FDI criteria (surface gloss, surface and marginal coloration, color and translucency correspondence, and aesthetic anatomical shape); however, it is important to report that the gingival condition presented inflammation in 12 cases.

The longevity of metal-ceramic single crowns cemented with self-adhesive cement was high after an up-to-106-month period prospective longitudinal study, with a survival rate of 93%. However, the success rate of restorations was indicated considering secondary outcomes, including post debonding, root fracture and loss of the element due to periodontal or caries disease. In this regard, 16 failures were reported, generating a success rate of 72%. Therefore, the hypothesis raised in our study (crowns cemented with self-adhesive cement must have high survival and success rates) is partially accepted, although it is evident that most restoration failures were due to factors not related to self-adhesive cement used in the cementation of metal-ceramic crown. Therefore, the use of this system is feasible and satisfactory, and may be clinically indicated.

A survival rate of 97% was observed for crowns cemented with self-adhesive resin cement with only three debondings in a previous study with this same sample after a shorter clinical follow-up time (up-to-72-months) [13]. Although the current follow-up found high survival rates, we observed the occurrence of five new debondings cases in the period of 2 years between the two evaluations. While self-adhesive dual polymerization cements show good behaviour in relation to sorption and solubility properties [16], this condition affects all materials, and this may be one of the reasons for debonding. In vitro studies where the effects of aging are evaluated on the bond strength of resin cements to different materials such as ceramic, composite resin and teeth show worse results with the application of thermocycling methods [17–20]. The different materials which compose the restorative complex present different degrees of contraction and expansion during temperature variation, generating defects between the adhesive interfaces [19]. Considering the presence of materials with different coefficients of thermal expansion (metal and composites), the constant thermal variation in the oral environment and the long-time of exposure to this condition, it is possible to assume that the aging process of materials led to an increase in failures in the last 2 years of evaluation.

The progressive loss of crown retention observed in the last evaluation period may be related to the fatigue after mechanical aging of the resin cement. The cement acts as an intermediate material in the crown-tooth restorative set, absorbing the impacts on the restoration arising from mastication and parafunctional habits. It is suggested that restorations with materials with higher elastic modulus reduce the stress concentration in the cement layer [21]. However, the application of intermittent loads over the years subject the materials to initiation and propagation of cracks, which become more likely to occur over time, leading to material failure through cohesive failures or failures of the adhesive interface [22]. There is a tendency for this outcome to intensify and continue to occur over the years due to the progressive loss of resistance of materials from fatigue. Therefore, it is necessary that the longitudinal follow-up of these cases be maintained and renewed in order to add relevant information to scientific knowledge.

Another factor which may be associated with this increase are the biological issues associated with poor oral hygiene. These factors have an important influence on the clinical behaviour of the materials [23]. Among the patients whose crowns did not fail, 12 were diagnosed with some degree of periodontal disease. In addition, there were three tooth losses included in the secondary outcome data. However, it is difficult to specify the cause of debonding of the crowns, especially because the possible predictor variables (number of remaining walls, tooth region in the arch, cementation length and type of antagonist) did not present characteristics that suggest some kind of interpretation about it. In any case, values above 90% survival rate are considered as good performance after a period of 5 years [24]. On average, we obtained a follow-up time of 62 months (approximately 5 years), and so we can consider that the results found were good, and that the cementation of metal-ceramic crowns with self-adhesive cement may be clinically indicated.

On the other hand, the occurrence of secondary outcomes led to a 72% success rate in the up-to-106-month follow-up for teeth restored with this restorative technique (Fig. 3). According to Anusavice (2012), a success rate of less than 90% is considered as poor performance [24]. In our study, more than half of the failure cases not related to crown cementation were due to root fracture. Until recently, this type of failure was associated with metal cast-and-cores, where the stress is concentrated on the root walls leading to this negative outcome [9]. However, it is currently questioned whether fibre posts do not lead to this type of outcome when the tooth has weakened conditions, pre-existing cracks or some accumulated damage in the remnant, suggesting a similar behaviour between metallic retainers and fibre posts [7, 25, 26].

It is suggested that post retention loss can lead to catastrophic root fracture as a subsequent consequence [8]. In addition to the nine root fractures, four post debondings were observed (Fig. 1). Thus, 54.17% of failures in our study were related to the post (considering root fracture or post debonding), while 33.33% occurred due to crown debonding. Thus, it is possible to infer that the biggest problem in the type of prosthetic reconstruction evaluated in our study is focused on the retainer, and therefore continuous clinical follow-up studies are needed to improve the choice for adequate retainers and cementation systems to obtain greater long-term success in these restorations [14].

Finally, we evaluated the aesthetic parameters in our study according to the FDI criteria [15]. In this regard, the crowns showed good results, showing that indirect restorations tend to remain in good shape even after long time periods. In view of these aspects, as well as the high survival rate obtained in our study, it is plausible to state that self-adhesive resin cement is a long-lasting choice for cementing metal-ceramic crowns.

As limitations of our study, it was not possible to analyse the failure origins, and therefore any more specific theoretical considerations about what led to their occurrence could be imprecise and erroneous. Furthermore, it is a prospective study without a control group, since all patients underwent the same type of restoration and resin cement. In addition, patients with different follow-up times were included in the sample. The analysis time was 62 months on average, being 2 years longer than the previous study with the same sample [13]. The continuous evaluation of these cases allows constant updating as well as longer-lasting data, providing relevant information for the literature, such as the increase in debonding cases over time, as observed in our most recent results.

The use of self-adhesive resin cement for cementation of metal-ceramic crowns can be clinically indicated, since a survival rate of 93% was obtained after an average follow-up of 62 months. Furthermore, the aesthetic features of the restorations remained satisfactory over time, with no changes in surface gloss, surface and marginal coloration, colour and translucency correspondence, or aesthetic anatomical shape that would indicate retreatment. On the other hand, a success rate of 72% was obtained considering the secondary outcome, especially related to the intraradicular retainer failure, and more studies should be carried out to improve this outcome.

Ethics approval

All procedures performed in studies involving human participants were carried out in accordance with guidelines and regulations ethical standards of the committee of the Federal University of Santa Maria, Brazil. The approval codes for this study are 099/2009 and 0170.1.243.000-09. The procedures were conducted according to the principles outlined in the Declaration of Helsinki and Ethical Conduct for Research with Human Beings and the Good Clinical Practice Guidelines, and registered in ClinicalTrials.gov (NCT01461239).

Informed consent

Written informed consent was taken from all participants included in the study.

Conflict of Interest

The authors declare there are no conflicts of interest.

Funding

This study was partly financed by the Brazilian National Council for Scientific and Technological Development, Brazil – CNPq (R.V.M. doctorate scholarship; project #161235/2021-2).

Author Statement

Renan Vaz Machry: Investigation, Data curation, Formal analysis, Validation, Visualization, Writing – original draft.

César Dalmolin Bergoli: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Visualization, Validation, Writing – review & editing.

Julia Kaster Schwantz: Investigation, Data curation, Writing – review & editing.

Lucas Pradebon Brondani: Investigation, Data curation, Project administration, Visualization, Writing – review & editing.

Tatiana Pereira-Cenci: Conceptualization, Resources, Supervision, Project administration, Visualization, Writing – review & editing.

Gabriel Kalil Rocha Pereira: Conceptualization, Project administration, Formal analysis, Writing – review & editing.

Luiz Felipe Valandro: Conceptualization, Methodology, Visualization, Funding acquisition, Project administration, Resources, Supervision, Writing – review & editing.

Sailer I, Makarov NA, Thoma DS, et al (2015) All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs). Dent Mater 31:603–623. https://doi.org/10.1016/j.dental.2015.02.011
Masaka N, Yoneda S, Masaka K (2021) An up to 43-year longitudinal study of fixed prosthetic restorations retained with 4-META/MMA-TBB resin cement or zinc phosphate cement. J Prosthet Dent 1–6. https://doi.org/10.1016/j.prosdent.2021.04.004
Naumova EA, Ernst S, Schaper K, et al (2016) Adhesion of different resin cements to enamel and dentin. Dent Mater J 35:345–352. https://doi.org/10.4012/dmj.2015-174
Ritter A V., Ghaname E, Pimenta LAF (2009) Dentin and enamel bond strengths of dual-cure composite luting agents used with dual-cure dental adhesives. J Dent 37:59–64. https://doi.org/10.1016/j.jdent.2008.09.006
Manso AP, Carvalho RM (2017) Dental Cements for Luting and Bonding Restorations: Self-Adhesive Resin Cements. Dent Clin North Am 61:821–834. https://doi.org/10.1016/j.cden.2017.06.006
Miotti LL, Follak AC, Montagner AF, et al (2020) Is conventional resin cement adhesive performance to dentin better than self-adhesive? a systematic review and meta-analysis of laboratory studies. Oper Dent 45:484–495. https://doi.org/10.2341/19-153-L
Marchionatti AME, Wandscher VF, Rippe MP, et al (2017) Clinical performance and failure modes of pulpless teeth restored with posts: a systematic review. Braz Oral Res 31:e64. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0064
Santos AFV, Meira JBC, Tanaka CB, et al (2010) Can fiber posts increase root stresses and reduce fracture? J Dent Res 89:587–591. https://doi.org/10.1177/0022034510363382
Naumann M, Sterzenbach G, Dietrich T, et al (2017) Dentin-like versus Rigid Endodontic Post: 11-year Randomized Controlled Pilot Trial on No-wall to 2-wall Defects. J Endod 43:1770–1775. https://doi.org/10.1016/j.joen.2017.06.030
Cotes C, Cardoso M, de Melo RM, et al (2015) Effect of composite surface treatment and aging on the bond strength between a core build-up composite and a luting agent. J Appl Oral Sci 23:71–78. https://doi.org/10.1590/1678-775720140113
Klosa K, Shahid W, Aleknonyte-Resch M, Kern M (2020) Cleaning and conditioning of contaminated core build-up material before adhesive bonding. Materials (Basel) 13:1–15. https://doi.org/10.3390/ma13122880
Jamel RS, Nayif MM, Abdulla MA (2019) Influence of different surface treatments of nickel chrome metal alloy and types of metal primer monomers on the tensile bond strength of a resin cement. Saudi Dent J 31:343–349. https://doi.org/10.1016/j.sdentj.2019.03.006
Brondani LP, Pereira-Cenci T, Wandsher VF, et al (2017) Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study. Braz Oral Res 31:e22. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0022
Bergoli CD, Brondani LP, Wandscher VF, et al (2018) A multicenter randomized double-blind controlled clinical trial of fiber post cementation strategies. Oper Dent 43:128–135. https://doi.org/10.2341/16-278-C
Hickel R, Peschke A, Tyas M, et al (2010) FDI World Dental Federation: Clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples. Clin Oral Investig 14:349–366. https://doi.org/10.1007/s00784-010-0432-8
Kim HJ, Bagheri R, Kim YK, et al (2017) Influence of curing mode on the surface energy and sorption/solubility of dental self-adhesive resin cements. Materials (Basel) 10:. https://doi.org/10.3390/ma10020129
Elsaka SE, Elnaghy AM (2020) Effect of surface treatment and aging on bond strength of composite cement to novel CAD/CAM nanohybrid composite. J Adhes Dent 22:195–204. https://doi.org/10.3290/j.jad.a44284
Ilie N, Ruse ND (2019) Shear bond strength vs interfacial fracture toughness — Adherence to CAD/CAM blocks. Dent Mater 35:1769–1775. https://doi.org/10.1016/j.dental.2019.10.003
Machry R V., Fontana PE, Bohrer TC, et al (2020) Effect of Different Surface Treatments of Resin Relined Fiber Posts Cemented With Self-adhesive Resin Cement on Push-out and Microtensile Bond Strength Tests. Oper Dent 45:E185–E195. https://doi.org/10.2341/19-108-L
Van Meerbeek B, Frankenberger R (2020) The value and remaining NEED of bond-strength testing. J Adhes Dent 22:123–124. https://doi.org/10.3290/j.jad.a44440
Tribst JPM, Dal Piva AM de O, de Jager N, et al (2021) Full-Crown Versus Endocrown Approach: A 3D-Analysis of Both Restorations and the Effect of Ferrule and Restoration Material. J Prosthodont 30:335–344. https://doi.org/10.1111/jopr.13244
Arola D (2017) Fatigue testing of biomaterials and their interfaces. Dent Mater 33:367–381. https://doi.org/10.1016/j.dental.2017.01.012
Demarco FF, Corrêa MB, Cenci MS, et al (2012) Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 28:87–101. https://doi.org/10.1016/j.dental.2011.09.003
Anusavice KJ (2012) Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses. Dent Mater 28:102–111. https://doi.org/10.1016/j.dental.2011.09.012
Figueiredo FED, Martins-Filho PRS, Faria-E-Silva AL (2015) Do metal post-retained restorations result in more root fractures than fiber post-retained restorations? A systematic review and meta-analysis. J Endod 41:309–316. https://doi.org/10.1016/j.joen.2014.10.006
Martins MD, Junqueira RB, de Carvalho RF, et al (2021) Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis. J Dent 112:. https://doi.org/10.1016/j.jdent.2021.103750

No competing interests reported.

Download PDF

Editorial decision: Major revision
09 Jul, 2022
Reviews received at journal
01 Jul, 2022
Reviewers agreed at journal
28 Jun, 2022
Reviewers invited by journal
27 Jun, 2022
Submission checks completed at journal
24 Jun, 2022
Editor assigned by journal
24 Jun, 2022
First submitted to journal
07 Jun, 2022

You are reading this latest preprint version

Longevity of metal-ceramic single crowns cemented with self-adhesive resin cement: An update of a prospective analysis with up to 106 months of follow-up

Status:

Version 1

Abstract

Figures

1. Introduction

2. Methods And Materials

2.1. Study design, ethical aspects and sample description

2.2. Operator’s Clinical Training

2.3. Clinical Procedures

2.4. Evaluation methods

2.5. Statistical Analysis

3. Results

4. Discussion

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1