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Comments regarding: Batista VES, Bitencourt SB, Bastos NA, Pellizzer EP, Goiato MC, Dos Santos DM. Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis. J Prosthet Dent 2020;123:239-45

Comments regarding: Batista VES, Bitencourt SB, Bastos NA, Pellizzer EP, Goiato MC, Dos Santos DM. Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis. J Prosthet Dent 2020;123:239-45

Comments regarding: Batista VES, Bitencourt SB, Bastos NA, Pellizzer EP, Goiato MC, Dos Santos DM. Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis. J Prosthet Dent 2020;123:239-45

Journal of Prosthetic Dentistry, 2021-03-01, Volume 125, Issue 3, Pages 554-554, Copyright © 2020 Editorial Council for the Journal of Prosthetic Dentistry

In an article by Batista VES, Bitencourt SB, Bastos NA, Pellizzer EP, Goiato MC, Dos Santos DM. (Influence of the ferrule effect on the failure of fiber-reinforced composite post-and-core restorations: A systematic review and meta-analysis. J Prosthet Dent 2020; 123:239-45), the authors concluded that after 4 studies met the preestablished selection criteria, the results of the systematic review and meta-analysis suggested that the ferrule effect does not significantly reduce the failure rate in fiber-reinforced composite post-and-core restorations. However, 1 of the 4 studies was misrepresented in the data analysis. The study by Bitter et al was the only study not to show a tangible difference in survival of fiber post restorations between the group with a ferrule and the group without a ferrule. This was depicted in Table 2 of the systematic review and meta-analysis claiming that 40 participants were restored with a post on teeth with a ferrule and 21 participants were restored with a post on teeth without a ferrule, leading to a 95% survival rate with a ferrule and 95.1% without a ferrule. However, the authors of the systematic review and meta-analysis misinterpreted the subset of teeth, described in the study by Bitter et al, with “no wall exceeding 2 mm above the gingival level” as being the cohort of 21 participants with teeth without a ferrule. In fact, all crown preparations were performed with a circumferential ferrule of at least 2 mm in the study by Bitter et al (pg. 1478, Material and Methods).

All other selected studies in the systematic review and meta-analysis showed marked differences in survival rate between restorations with and without a ferrule, favoring a ferrule (Table 2). Given this misrepresentation of 25% of the selected studies, the conclusion by the authors that the ferrule effect does not appear to reduce the failure rate of fiber-reinforced composite post-and-core restorations significantly, when compared with its absence, cannot be supported.

References

  • 1. Bitter K., Noetzel J., Stamm O., Vaudt J., Meyer-Lueckel H., Neumann K., et. al.: Randomized clinical trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months. J Endod 2009; 35: pp. 1477-1482.
  • 2. Ferrari M., Vichi A., Fadda G.M., Cagidiaco M.C., Tay F.R., Breschi L., et. al.: A randomized controlled trial of endodontically treated and restored molars. J Dent Res 2012; 91: pp. 72s-78s.
  • 3. Mancebo J.C., Jimenez-Castellanos E., Canadas D.: Effect of tooth type and ferrule on the survival of pulplessteeth restored with fiber posts: a 3-year clinical study. Am J Dent 2010; 23: pp. 351-356.
  • 4. Cagidiaco M.C., Garcia-Godoy F., Vichi A., Grandini S., Gorachi C., Ferrari M.: Placement of fiber prefabricated or custom made posts affects the 3-year survival od endodontically treated posts affects the 3-year survival of endodontically treated premolars. Am J Dent 2008; 21: pp. 179-184.