Mechanical behavior of endocrown vs. post-and-crown: a systematic review and meta-regression analysis

This systematic review and meta-regression analysis compared the load-to-fracture of endodontically treated teeth restored with endocrown and post-and-crown restorations, identifying factors influencing their mechanical behavior. Literature search in PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and LILACS included studies published until September 2025. The search strategy combined Medical Subject Headings and free-text keywords. Two independent researchers performed the study selection. The eligibility criteria considered in vitro studies that evaluated the load-to-fracture of endodontically treated teeth restored with endocrowns and had a control group consisting of teeth restored with post-and-crown. From 862 studies, 25 met the eligibility criteria. The final meta-regression model explained 86% of the within-group variance, showing no significant differences in the load-to-fracture between endocrowns and post-and-crown restorations (p>0.05). The type of teeth, ferrule presence, and restoration material did not significantly influence the outcomes, whereas luting material and load application angle were critical determinants of load-to-fracture performance. Resin composite significantly increased the load-to-fracture compared to conventional resin cement (p<0.05). Oblique forces during mechanical tests reduced the load-to-fracture values (p<0.05). In conclusion, similar load-to-fracture performance is expected between endocrown and post-and-crown restorations. Luting material and mechanical testing parameters influenced outcomes and may have contributed to heterogeneity in prior meta-analyses.