Clinical Outcomes and Complication Rates of Crown Restorations with Various Endodontic Posts: A Retrospective Analysis.

Objective

This retrospective study was conducted to evaluate long-term outcomes lcomplication rates of crown restorations supported by different types of endodontic posts and to determine the influence of post material on biological and technical outcomes. Materials and

Methods

Clinical and radiographic data from 437 crowned teeth retained by fiber, metallic, or custom-made posts were collected at Qassim University Dental Hospital between August and November 2025. Biological (secondary caries, periapical lesions) and technical (debonding, fracture, chipping) complications were recorded. Kaplan-Meier and life-table analyses were used to estimate complication-free survival, and Cox regression was employed to identify significant predictors (α = 0.05).

Results

The mean observation period was 6.76 ± 4.88 years. The overall complication rate was 56.8%. Crowns restored with fiber posts exhibited the lowest complication rate (40.0%) and the highest 15-year cumulative survival (52%), followed by custom-made (38%) and metallic posts (15%). Fiber posts demonstrated a significantly lower hazard of complications than metal posts (HR = 1.70, p = 0.009). Female sex (HR = 1.69, p = 0.001) and mandibular location (HR = 1.36, p = 0.048) were associated with increased risk. Metal-ceramic crowns showed a protective effect compared to ceramic crowns (HR = 0.56, p = 0.001).

Conclusions

The type of post significantly affected long-term prognosis of crowned endodontically treated teeth. Fiber posts provided the most favorable outcomes by minimizing catastrophic root fractures, while metallic and custom-made posts demonstrated higher complication hazards. Crown material, arch location, and patient factors further influenced survival outcomes.