Análise da performance clínica de coroas endocrowns para reconstrução de dentes tratados endodonticamente com diferentes materiais cerâmicos ou dentes. Revisão sistemática e meta-análise

Abstract

The restoration of endodontically treated teeth has demanded the use of alternatives that are less harmful to the tooth structure, especially because the treatment itself already generates the weakening of this structure. Thus, while adhesive dentistry was developing, a new restorative technique emerged, the endocrown, a monobloc restoration that has several materials for its execution, each with a performance and with the possibility of use in the completely digital flow, CAD/CAM. Therefore, the present study aimed to evaluate, through a systematic review with meta- analysis, the survival and success of endocrowns by specifically analyzing the influence of the ceramic restorative material and the type of tooth involved. A total of 19 trials were included for analysis, totaling 1602 endocrowns. It was possible to observe reduced failure rates for endocrowns, which presented a proportion of 5% (CI: 2-10%). Regarding the type of tooth, similarities were observed in the failure rates for molars (3%; CI: 0-8%) and premolars (3%; CI: 0-19%), however, high values were observed for anterior teeth (25%; CI: 9-41%). In addition, differences were found between the restorative materials evaluated: lithium disilicate (9%; CI: 0-28%), polymer-infiltrated hybrid ceramics (6%; CI: 0-21%), zirconia (2%; CI: 0-13%), in-ceram/alumina (7%; CI: 1-16%), nanoceramic resin (25%; CI: 1-62%). Most of the included studies were of favourable quality. In addition, there was a higher proportion of studies considering endocrowns in posterior teeth than anterior ones. In general, the conclusion of this study is that endocrowns should be considered promising alternatives for endodontically treated teeth, especially in posterior teeth, due to the similarity in failure rates. In addition, the success and overall survival rates were 92% and 95%, respectively, considering the single-arm meta-analysis, with a value of p<0.01 for both. Finally, it can be considered that survival and success rates vary according to the selected material, and it is up to the professional to select the most appropriate material according to the patient's clinical characteristics and material properties.