Non-Cochrane · intervention · PM41659195
Fracture resistance of teeth restored with polyethylene fibers reinforced composite restorations: a systematic review and meta-analysis of in vitro studies.
Alvarado-Orozco Alejandra, Bourgi Rim, Rodríguez-Vilchis Laura Emma, et al. · Frontiers in dental medicine · 2025 · PubMed · doi:10.3389/fdmed.2025.1733879
Findings
Population Permanent teeth requiring restorative treatment (in vitro specimens)
4 findings
| Polyethylene fiber-reinforced fiber post (intraradicular) | Conventional fiber post / non-fiber-reinforced control | Number of unfavorable/catastrophic failures after fracture test After fracture strength test · Laboratory (in vitro) · Overall | RD -0.50 [-0.73, -0.27] GRADE not reported 2 studies · 40 participants |
| Polyethylene fiber-reinforced fiber post (intraradicular) | Conventional fiber post / non-fiber-reinforced control | Fracture resistance (N) After fracture strength test · Laboratory (in vitro) · Overall | SMD -0.76 [-1.17, -0.35] GRADE not reported 4 studies · 160 participants |
| Polyethylene fiber-reinforced composite resin restoration | Non-fiber-reinforced composite resin restoration | Fracture resistance (N) After fracture strength test · Laboratory (in vitro) · Overall | SMD -0.82 [-1.16, -0.49] GRADE not reported 28 studies · 1164 participants |
| Polyethylene fiber-reinforced composite resin restoration | Non-fiber-reinforced composite resin restoration | Number of unfavorable/catastrophic failures after fracture test After fracture strength test · Laboratory (in vitro) · Overall | RD -0.15 [-0.21, -0.09] GRADE not reported 17 studies · 726 participants |
Included primary studies 64
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Kumar 2013 matched by author and year (probable) | NR | 2 other reviews | Fracture resistance (N) | not extracted yet |
| Miao 2016 matched by author and year (probable) | NR | 1 other review | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Albar 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Albar 2023 Fracture Load of Mesio-Occluso-Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study. PMID:36987139 | 2023 | this review only | not stated | not extracted yet |
| Albashaireh 2024 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Albashaireh 2024 The effect of ferrule and core material on fracture resistance of endodontically treated anterior teeth restored with ceramic crowns after… PMID:38830530 | 2024 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Aljarboua 2024 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| AlJarboua 2024 Effect of Fiber-Reinforced Composite Placement Site on Fracture Resistance of Premolar Teeth: An in vitro Study. PMID:39006828 | 2024 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Aslan 2018 matched by author and year (probable) | NR | this review only | Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Aslan 2018 Evaluation of fracture resistance in root canal-treated teeth restored using different techniques. PMID:29888730 | 2018 | this review only | Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Ayad 2009 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Ayad 2009 Resin composite polyethylene fiber reinforcement: effect on fracture resistance of weakened marginal ridges. PMID:20718208 | 2010 | this review only | Fracture resistance (N) | not extracted yet |
| Badakar 2011 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Badakar 2011 Fracture resistance of microhybrid composite, nano composite and fibre-reinforced composite used for incisal edge restoration. PMID:21564519 | 2011 | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2005 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2005 The effect of fibre insertion on fracture resistance of root filled molar teeth with MOD preparations restored with composite. PMID:15667628 | 2005 | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2006 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2006 Reinforcement effect of polyethylene fibre in root-filled teeth: comparison of two restoration techniques. PMID:16454794 | 2006 | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2006 (b) matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Belli 2006 (b) The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual… PMID:16470831 | 2006 | this review only | Fracture resistance (N) | not extracted yet |
| Braga 2015 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Braga 2015 Rehabilitation of weakened premolars with a new polyfiber post and adhesive materials. PMID:26481888 | 2015 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Cobankara 2008 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Cobankara 2008 The effect of different restoration techniques on the fracture resistance of endodontically-treated molars. PMID:18833859 | 2008 | this review only | Fracture resistance (N) | not extracted yet |
| Costa 2014 Fracture resistance of mechanically compromised premolars restored with polyethylene fiber and adhesive materials DOI:10.1016/j.ijadhadh.2014.01.030 | 2014 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Costa 2014 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Deger 2023 The Effect of Different Intermediary Layer Materials Under Resin Composite Restorations on Volumetric Cuspal Deflection, Gap Formation,… PMID:36445957 | 2023 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Denger 2023 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Eliguzeloglu 2019 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Eliguzeloglu 2019 Can Fiber Application Affect the Fracture Strength of Endodontically Treated Teeth Restored with a Low Viscosity Bulk-Fill Composite? PMID:30805363 | 2019 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Fildisi 2022 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Fildisi 2022 The effect of fiber insertion on fracture strength and fracture modes in endocrown and overlay restorations. PMID:34964540 | 2022 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Garlapati 2017 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Garlapati 2017 Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material-An in vitro study. PMID:28279651 | 2017 | this review only | Fracture resistance (N) | not extracted yet |
| Hshad 2017 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Hshad 2017 Influence of Different Restoration Techniques on Fracture Resistance of Root-filled Teeth: In Vitro Investigation. PMID:29148912 | 2018 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Kalburge 2013 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Kalburge 2013 A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with… PMID:23965445 | 2013 | this review only | Fracture resistance (N) | not extracted yet |
| Kaynar 2025 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Kaynar 2025 Comparison of fracture resistance between immediate and delayed composite restorations with or without fiber after root canal treatment: a… PMID:40028222 | 2025 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Khan 2013 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Khan 2013 Effect of two different types of fibers on the fracture resistance of endodontically treated molars restored with composite resin. PMID:23534017 | 2013 | this review only | Fracture resistance (N) | not extracted yet |
| Khan 2018 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Khan 2018 Ex vivo fracture resistance of teeth restored with glass and fiber reinforced composite resin. PMID:29627734 | 2018 | this review only | Fracture resistance (N) | not extracted yet |
| Kumar 2013 Evaluation of fracture resistance of reattached vertical fragments bonded with fiber-reinforced composites: an in vitro study. PMID:24309329 | 2013 | this review only | Fracture resistance (N) | not extracted yet |
| Miao 2016 Fracture resistance of palatal cusps defective premolars restored with polyethylene fiber and composite resin. PMID:27252007 | 2016 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Mohammadipour 2025 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Mohammadipour 2025 Fracture Resistance of Fiber-Reinforced vs. Conventional Resin Composite Restorations in Structurally Compromised Molars: An In Vitro Study. PMID:40041724 | 2025 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Newman 2003 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Newman 2003 Fracture resistance of endodontically treated teeth restored with composite posts. PMID:12690348 | 2003 | this review only | Fracture resistance (N) | not extracted yet |
| Pierce 2025 Simplify the handling of penicillin on the ward. PMID:20252649 | 1947 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Pierce 2025 Fracture Resistance and Failure Modes of Cuspal-coverage Restorations Using Fiber-reinforced and Non-fiber-reinforced Materials: An In… PMID:40254864 | 2025 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Segun 2008 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Segun 2008 Effect of a new restoration technique on fracture resistance of endodontically treated teeth. PMID:18352927 | 2008 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Shah 2020 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Shah 2020 Performance of fibre reinforced composite as a post-endodontic restoration on different endodontic cavity designs- an in-vitro study. PMID:32174408 | 2020 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Soto-Cadena 2023 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Soto-Cadena 2023 Effect of short fiber-reinforced composite combined with polyethylene fibers on fracture resistance of endodontically treated premolars. PMID:37030918 | 2023 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Sreen 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sreen 2022 Comparative evaluation of the force required to fracture coronal segments reattached using different methods. PMID:34936196 | 2022 | this review only | not stated | not extracted yet |
| Tsertsidou 2023 matched by author and year (probable) | NR | this review only | Fracture resistance (N) | not extracted yet |
| Tsertsidou 2023 Fracture Resistance of Class II MOD Cavities Restored by Direct and Indirect Techniques and Different Materials Combination. PMID:37631470 | 2023 | this review only | Fracture resistance (N) | not extracted yet |
| Yuksek 2025 matched by author and year (probable) | NR | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
| Yuksek 2025 Influence of cusp reduction and fiber reinforcement on cusp deflection and fracture strength of restored endodontically treated molar teeth. PMID:40183832 | 2025 | this review only | Fracture resistance (N); Number of unfavorable/catastrophic failures after fracture test | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Permanent teeth requiring restorative treatment | Human permanent teeth, mostly endodontically treated, Class I and II and MOD cavities, or post spaces (32 studies) |
| Intervention | Restoration with polyethylene fiber-reinforced composite resin or polyethylene fiber-reinforced fiber posts | Polyethylene fibers, mostly Ribbond, in composite restorations or fiber posts (30 studies in meta-analysis) |
| Comparison | Non-fiber-reinforced composite resin, or conventional fiber posts | Composite resin without fiber reinforcement; conventional fiber posts |
| Outcomes | Fracture resistance (N); unfavorable or catastrophic failures after the fracture test | Fracture resistance SMD (composite restorations 28 studies; posts 4 studies); unfavorable fractures RD (composite 17 studies; posts 2 studies) |
| Study designs | In vitro studies in English reporting mean and SD | 32 in vitro studies in qualitative synthesis; 30 in meta-analysis |
| Timing | No date restriction; search to May 18, 2025 | Immediate to aged specimens; monotonic static loading only |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Partial Yes | NRSI: N/A · RCT: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: No | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |