One-piece endodontic crowns in posterior teeth: An overview of systematic reviews

The outcome of posterior nonvital teeth depends not only on endodontic factors but also on the effectiveness of the restoration. The growing trend in minimally invasive dentistry has led to increasing interest in 1-piece endodontic crowns as an alternative restoration. Nevertheless, their indications and longevity lack extensive exploration, thereby limiting their widespread acceptance in dental practice.

The purpose of this overview was to synthesize the available evidence from systematic reviews (SRs) about 1-piece endodontic crowns and to identify clinical outcomes such as survival, success rates, and patient-reported outcome measures (PROMs).

A systematic search was performed in the electronic databases MEDLINE/PubMed, Cochrane, Web of Science, and OpenGrey, as well as a manual search, up to June 2024, with no language or time restriction. SRs that addressed clinical studies related to 1-piece endodontic crowns or endocrowns were included. The risk of bias and methodological quality was measured using the ROBIS and AMSTAR-2 tools, respectively.

The search identified 468 articles, of which 9 SRs were included. The best evidence reported in the SRs was that survival or success rates for ceramic and indirect resin 1-piece endodontic crowns were high at 5 years, similar to those for conventional crowns. Loss of retention was the main cause of failure with similar failure rates for molars and premolars. Evidence for the use of zirconia and metal 1-piece endodontic crowns is limited, and no SR was found that addressed PROMs. Methodological quality was considered low or critically low in most SRs. However, the risk of bias was low for 2 of the 3 SRs that provided the best evidence in the meta-analysis for ceramic and indirect resin 1-piece endodontic crowns. Overlap in the included studies was very high.

Although the evidence generated by multiple RS only determined that ceramic and indirect resin 1-piece endodontic crowns can be a suitable and reliable option for restoring endodontically treated premolars and molars, with high success and survival rates comparable with those of complete crowns with posts, this overview concluded that it was not possible to provide firm conclusions regarding the outcomes of 1-piece endodontic crowns because of the lack of adequate high-quality primary studies with different materials, heterogenicity of the studies, variations in follow-up, preparation, and operative steps, and very high overlap of studies. Thus, additional well-designed clinical trials are necessary rather than SRs to strengthen the evidence in this area.