Table 3 Descriptive data of included studies

Cobankara et al. 2008 [40]

The Effect of Different Restoration Techniques on the Fracture Resistance of Endodontically-treated Molars

Mandibular Molars

PC, NC

MOD

Step back technique with hand instruments upto #35. Irrigation performed using 5.25% NaOCl

AH Plus, CLC

Cross head speed 1 mm/minute, 6 mm stainless

steel bar used to fracture

1. CavexAvalloy-II spill, Lathe-cut silver

alloy for dental amalgam

2. ClearfilPhotoposterior, Kuraray

3. Estenia Indirect Hybrid Ceramic Inlay

4. Polyethylene Ribbon Fiber (Ribbond)

Favourable

Indirect hybrid ceramic inlay seemed more reliable

because of higher fracture strength and prevention of unfavourable fractures.

Srirekha et al. 2012 [21]

The reinforcement effect of polyethylene fiber and composite impregnated glass

fiber on fracture resistance of endodontically treated teeth

Maxillary Premolars

PC

MOD

Rotary instrumentation with ProTaper Files upto F2. Irrigation performed using 5.25% NaOCl

AH Plus, CLC,SC

NM, 5 mm diameter

round stainless

steel ball used to fracture

1. Filtek Z350 XT

2. Interlig; Angelus

3. Ribbond

NM

Composite impregnated glass fiber-reinforced group possessed higher Fracture Strength.

Khan et al., 2013 [41]

Effect of Two Different Types of Fibers on the Fracture Resistance of Endodontically Treated Molars Restored with Composite Resin

Mandibular Molars

PC, NC

MOD

Step back technique with hand instruments upto #35 for Distal canals and

#40 for mesial canals. Irrigation performed using 5.25% NaOCl

AH Plus, CLC

0.5 mm/min, 6 mm diameter

stainless steel bar used to fracture

1. Hybrid Resin Composite, Venus Heraeus Kulzer

2. Leno Woven Ultrahigh Molecular weight (LWUHM)

polyethylene fiber (Ribbond; Seattle, WA, USA)

3.Vectris®Ivoclar Vivadent

NM

Insertion of polyethylene ribbon fibers in root filled molars with MOD preparation significantly

increased the fracture strength.

Kalburge et al., 2013 [23]

A comparative evaluation of fracture resistance of endodontically treated

teeth, with variable marginal ridge thicknesses, restored with composite resin

and composite resin reinforced with Ribbond: An in vitro study

Maxillary Premolars

PC, NC

MOD

NM

NM

2 mm/min

1. Filtek Z‑100 (3 M ESPE)

2. Polyethylene Fiber Ribbond (Ribbond; Seattle, WA, USA)

NM

On static loading, preserving the mesial marginal ridge of Composite‑restored and Ribbond‑reinforced composite‑restored maxillary premolars can help preserve the fracture resistance of teeth.

Costa et al., 2014 [42]

Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and

adhesive materials

Maxillary Premolars

PC

MODP

Rotary instrumentation with ProTaper Files upto F3. Irrigation performed using 1% NaOCl

AH Plus, CLC,SC

1 mm/min, Rectangular

round-tipped

metal point used to fracture

1. Filtek Z250;3 M ESPE

2. Fiber Post(Angelus,Londrina)

3. Ribbond (Ribbond; Seattle, WA, USA)

Favourable

Ribbon–fiber-reinforced resin restorations provided superior fracture resistance of premolars with MODP and endodontic access cavities.

Kemaloglu et al. 2015 [43]

Effect of novel restoration techniques on the fracture resistance of teeth treated

endodontically: An in vitro study

Mandibular Premolars

No Control Group

MOD

Rotary instrumentation with ProTaper Files upto F5. Irrigation performed using 2.5% NaOCl

AH Plus, SC

1 mm/min, Modified steel

Ball used to fracture

1. Filtek Z550;3 M ESPE

2. Ribbond (Ribbond; Seattle, WA, USA)

3. EverX Posterior (GC everX posterior, GC Corp)

4. Filtek Bulk Fill;3 M ESPE

Favourable

Fiber-reinforcement improved the fracture strength of teeth with large MOD cavities treated endodontically.

Atalay et al. 2016 [26]

Fracture Resistance of

Endodontically Treated Teeth Restored With Bulk Fill, Bulk Fill Flowable, Fiber-reinforced, and Conventional Resin Composite

Maxillary Premolars

PC, NC

MOD

Rotary instrumentation with ProTaper Files upto F3. Irrigation performed using 5.25% NaOCl

AH Plus, SC

1 mm/min, Steel sphere 8 mm

in diameter used to fracture

1. Filtek Bulk Fill Posterior Restorative

2. Bulk Fill Flowable Composite (SureFil SDR Flow)

3. Fiber-reinforced composite (GC everX posterior, GC Corp)

4. Conventional Nanohybrid Resin Composite

Tetric N-Ceram, (Ivoclar/Vivadent)

Favourable

The fracture resistance values of endodontically treated teeth restored with either bulk fill/bulk fill flowable or fiber-reinforced composite were not different from those restored with conventional nanohybrid resin composite.

Bilgi et al. 2016 [44]

Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and

fiber-reinforced composite: An in vitro study

Maxillary Premolars

PC

MOD

Step back technique with hand instruments. Irrigation performed using 5.25% NaOClv

AH Plus, CLC

1 mm/min, 0.5 mm diameter

round bar used to fracture

1. Conventional nanohybrid composite + Glass fiber

2. Silorane Composites

3. EverXposterior (GC everX posterior, GC Corp)

NM

Among the experimental groups, fiber‑reinforced composite showed the highest fracture resistance.

Gürel et al. 2016 [45]

Fracture Resistance of Premolars Restored Either with Short Fiber or Polyethylene Woven Fiber-Reinforced Composite

Maxillary Premolars

No Control Group

MODP

Rotary instrumentation with ProTaper Files upto F5. Irrigation performed using 2.5% NaOCl

AH Plus, SC

1 mm/min, Stainless steel ball

4 mm in diameter used to fracture

1. SFRC (EverX Posterior, GC)

2. Conventional Filler Composite (G-aenial Posterior, GC)

3. PWFP post (Ribbond thin, Ribbond Inc; Seattle, WA)

Favourable

The restoration of severely weakened premolar teeth

with the use of short fiber-reinforced composite

might have advantages over conventional filler composite or polyethylene woven fiber-reinforced composite techniques.

Yasa et al. 2016 [46]

Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth

Mandibular Molars

PC

MOD

Rotary instrumentation with ProTaper Files upto F2 in Mesial Canals,

F3 in Distal Canals. Irrigation performed using 2.5% NaOCl, 17% EDTA

AH Plus, SC

1 mm/min, Steel spherical tip

with a

diameter of 6 mm used to fracture

1. Nano-hybrid composite resin (FiltekTM Z550 ;3 M ESPE)

2. Bulk-fill flowable (FiltekTM Bulk Fill ;3 M ESPE)

3. Short fiber-reinforced-composite (everX Posterior TM)

Non Favourable

The use of short fiber-reinforced composite with retentive slots could prevent cuspal fracture on

endodontically-treated teeth with MOD cavity.

Ozsevik et al. 2016 [30]

Effect of fiber-reinforced composite on the fracture resistance of endodontically treated teeth

Mandibular Molars

PC, NC

MOD

Step back technique with hand instruments upto #35. Irrigation performed using NaOCl

AD Seal

(MetaBiomed, CLC

1 mm/min, Steel round-shaped

tip with a diameter

of 5 mm used to fracture

1. G–ænial posterior, GC Corporation

2. Ribbond (Ribbond Inc; Seattle, WA)

3. EverXposterior, GC Corporation

NM

EverX posterior under composite restorations resulted in fracture resistance similar to that of intact

teeth.It reinforced root-filled teeth more than composite alone and ribbon and composite

restorations.

Eapen et al. 2017

[47]

Fracture Resistance of Endodontically Treated

Teeth Restored with 2 Different Fiber-reinforced Composite and 2 Conventional Composite Resin Core Buildup Materials

Maxillary Premolars

PC, NC

MOD

Step back technique with hand instruments upto #40. Irrigation performed using 5.25% NaOCl

AH Plus, CLC

1 mm/min, Metal indenter with

a 6-mm diameter used to fracture

1. Dual Cure Composite MutiCore Flow (Ivoclar Vivadent)

2. Posterior Resin Composite Filtek P60 (3 M ESPE)

3. Fiber-reinforced Composites- Interlig Fiber (Angelus)

4. Short Fiber Composites EverXPosterior (GC Company)

Favourable

Short fiber-reinforced composite can be used as a direct core buildup material that can effectively resist heavy occlusal forces against fracture and may

reinforce the remaining tooth structure in endodontically treated teeth.

T.G. Garlapati et al. 2017 [48]

Fracture resistance of endodontically treated

teeth restored with short fiber composite used

as a core material

Mandibular Molars

PC, NC

MOD

Step back technique with hand instruments upto #35 for Distal canals

and #30 for Mesial

Canals. Irrigation performed using 3% NaOCl

AH Plus, CLC

0.5 mm/min, 6 mm stainless

steel sphere used to fracture

1. Hybrid composite (Te-EconomPlus,IvoclarVivadent, Asia)

2. Leno Woven Ultrahigh Molecular weight (LWUHM)

polyethylene fiber(Ribbond; Seattle, WA, USA)

3. everX posterior (GC EUROPE)

Favourable

Endodontically treated teeth restored with EverX posterior fiber-reinforced composite showed superior fracture resistance.

Özyürek et al. 2018 [33]

The Effects of Endodontic Access Cavity Preparation Design on the Fracture Strength of Endodontically Treated Teeth: Traditional Versus Conservative Preparation

Mandibular Molars

PC

Conservative

Endodontic

Access and

Traditional

Access

Rotary instrumentation with ProTaper

Next Files upto X2 for Mesial Canals,

X4 for Distal Canals. Irrigation performed using 5.25% NaOCl

AH Plus, SC

1 mm/min, 6-mm round-head

tip used to fracture

1. EverX posterior (GC EUROPE)

2. SDR (Dentsply Caulk, Milford, DE)

Favourable in ExP

in CEC and

Unfavorable in ExP

in TEC

The fracture strength of teeth restored with the SDR bulk-fill composite was higher than that of teeth restored with EverX Posterior.

Shah et al. 2020

[34]

Performance of fiber-reinforced composite as a post-endodontic restoration on different

endodontic cavity designs

Maxillary Premolars

PC, NC

MO & MOD

Step back technique with hand instruments upto #35. Irrigation performed using 5.25% NaOCl

AH Plus, CLC

0.5 mm/min, 6 mm Stainless

steel sphere used to fracture

1. Hybrid composite (Te-Econom Plus, Ivoclar Vivadent,

Asia)

2. EverX Posterior GC Corporation,Europe

3. Leno Woven Ultrahigh Molecular weight (LWUHM)

polyethylene fiber (Ribbond; Seattle, WA, USA)

Favourable

Fiber-reinforced composites when used in different cavity configurations of endodontically treated Premolar yielded similar results. More favourable fractures were seen in teeth restored with fiber-reinforced composites when compared to conventional composites

Donova et al. 2019

[49]

Direct bilayered biomimetic composite restoration: The effect of a cusp-supporting short fiber-reinforced base design on the chewing fracture resistance and failure mode of molars with or without endodontic treatment

Maxillary Third Molars

PC

MODP

Protaper upto F3, 2.5% Sodium Hypochlorite used as an irrigant

AH Plus and CLC

Cross head speed of 1 mm/min. Metal sphere with a diameter of 6 mm with tripod contact (the mesiobuccal, distobuccal and mesiopalatal cusps)

Direct composite resin (GC Posterior, GC, Tokyo, Japan) and Short-FRC (everX Posterior, GC Corporation, Tokyo, Japan)

Cavities restored without SFRC base showed unfavourable mode of fracture

A cusp-supporting design made of a short-FRC base (everX Posterior) improved the chewing fracture resistance and fracture manner of compromised molars.

Frankenberger et al. 2021 [38]

Post-Fatigue Fracture and Marginal Behavior of Endodontically Treated Teeth: Partial Crown vs. Full Crown vs. Endocrown vs. Fiber-Reinforced Resin Composite

Mandibular 3rd Molars

PC

MOD

MTwo upto size 0.04/#40, Irrigation solutions not mentioned.

AH Plus and CLC

0.5 mm/min. Steatite ball, 6 mm diameter.

Tetric EvoCeram BulkFill bonded with AdheSE Universal, EverX Posterior bonded with G-Premio Bond, e.max CAD, Celtra Duo Partial and Full Crowns, Zirconia Partial and Full Crowns, indirect non-bonded cast gold restorations.

All the failed Restorations showed an Unfavourable mode of fracture

Indirect restoration with cuspal coverage is suitable for the restoration of endodontically treated teeth in MOD cavities. All indirect restorations showed a promising performance after in vitro fatigue-loading compared to direct composite and fiber reinforced composite.

Volom et al. 2023 [35]

Fatigue performance of endodontically treated molars reinforced with diferent fiber systems

Mandibular Molars

Control (MOD Cavities restored with FRCs)

MOD

ProTaper upto F3, Irrigation with 5% NaOCl and 10% EDTA

AH Plus and Matched Single Cone

Round-shaped metallic tip 6 mm in diameter, Cross head speed not mentioned

EverX Flow, EverX Flow + G-aenial Injectable, Ribbond + G-aenial Posterior, Ribbond + G-aenial Flow, Fiber Post (FibreKleer, Petron, Orange, CA, USA), Fiber Post (FibreKleer, Petron, Orange, CA, USA) + G-aenial Flow

NM

Teeth restored with Short Fiber reinforced Composite restorations performed better without Cuspal Coverage compared to the ones where Short Fiber reinforced Composite was covered. For MOD cavities in endodontically treated molars, direct cuspal coverage is recommended when utilizing long continuous fbers for reinforcement.