Effect of Preparation Design on Marginal Integrity and Fracture Resistance of Endocrowns: A Systematic Review

Objectives: Endocrown restorations were introduced for endodontically treated teeth as a conservative treatment. However, data about the effect of preparation design on marginal integrity and fracture resistance of endocrowns are lacking. The purpose of this systematic review was to investigate the effect of preparation design of endocrown restorations on marginal integrity and fracture resistance. Materials and Methods: Based on PICO question and the search terms, PubMed, Embase, Scopus, and the Cochrane Library were searched. After including studies matched to predefined inclusion and exclusion criteria, the extracted data were tabulated in a table provided by the authors. Two reviewers assessed the methodological quality of each included study independently. Ten articles were selected for extracting the quantitative data. All included studies were in vitro. The potential risk of bias of the selected studies was assessed using the modified MINORS scale. Results: Four studies assessed the marginal adaptation, five studies evaluated the fracture resistance and just one investigated both the marginal integrity and fatigue resistance of the specimens. The evaluated influencing items in preparation design were as follows: cavity depth, occlusal thickness, ferrule effect, internal divergence angle, type of finish line, and adding vents inside pulp chamber. Meta-analysis could not be done due to heterogeneity of preparation designs and evaluation methods. Conclusion : Marginal discrepancy of endocrowns is intensified with adding preparation features, higher cavity depth and increasing the divergence. Fracture resistance of endocrowns is increased with more occlusal reduction and cavity depth. However, it is still beyond the normal clinical force range.