Research Article

eISSN 2234-7666
Restor Dent Endod. 2025 Feb;50(1):e5
https://doi.org/10.5395/rde.2025.50.e5

Fracture resistance and failure modes of endodontically-treated

permanent teeth restored with Ribbond posts vs other post systems:
a systematic review and meta-analysis of in vitro studies
Meghana Aditya Vartak* , Vibha Rahul Hegde , Sanitra Rahul Hegde , Ushaina Fanibunda*

Department of Conservative Dentistry and Endodontics, Post Graduate Program, YMT Dental College and Hospital, Navi Mumbai, India

ABSTRACT
Objectives: This systematic review aimed to investigate the fracture resistance and mode of failure of endodontical-
ly-treated permanent teeth restored with Ribbond posts (Ribbond, Inc.) compared with endodontically-treated perma-
nent teeth restored with other post systems.
Methods: A comprehensive, systematic literature search was carried out using several electronic databases: MEDLINE/
PubMed, Google Scholar, and Cochrane Library. Two separate researchers were appointed to identify the studies meet-
ing the eligibility criteria, and to perform the data extraction, risk of bias, and quality assessment.
Results: Twelve studies were included in the quantitative analysis. Meta-analysis was performed with 11 of the 12 includ-
ed articles. The meta-analysis showed that Ribbond posts have a fracture strength less than prefabricated metal posts,
cast metal posts, and prefabricated fiber posts and greater than custom e-glass fiber posts. Mode of failure analysis re-
vealed that Ribbond posts have the most favorable non-catastrophic fractures.
Conclusions: Although Ribbond posts have lower fracture resistance, their favorable mode of failure makes them poten-
tially the most biomimetic post system.

Keywords: Fracture strength; Post and core technique; Ribbond; Systematic review

Received: July 31, 2024 Revised: October 3, 2024 Accepted: November 10, 2024
Citation
Vartak MA, Hegde VR, Hegde SR, Fanibunda U. Fracture resistance and failure modes of endodontically-treated permanent teeth restored
with Ribbond posts vs other post systems: a systematic review and meta-analysis of in vitro studies. Restor Dent Endod 2024;50(1):e5.
*Correspondence to
Meghana Aditya Vartak, BDS, MDS
Department of Conservative Dentistry and Endodontics, YMT Dental College and Hospital, Institutional Area, Sector 4, Kharghar, Navi
Mumbai, Maharashtra 410210, India
Email: meghanavartak@gmail.com
*Correspondence to
Ushaina Fanibunda, BDS, MDS
Department of Conservative Dentistry and Endodontics, YMT Dental College and Hospital, Institutional Area, Sector 4, Kharghar, Navi
Mumbai, Maharashtra 410210, India
Email: ushaina@gmail.com
Meghana Aditya Vartak and Ushaina Fanibunda contributed equally to this work as corresponding authors.
© 2025 The Korean Academy of Conservative Dentistry
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

https://rde.ac 1/19
 Ribbond posts vs other post systems

INTRODUCTION This led to a shift in the trend from using more rigid
posts to using prefabricated fiber posts which had great-
Restoration of endodontically-treated teeth presents er elasticity and better esthetics [14]. Their lower elastic
a persistent clinical challenge as they are frequently modulus leads to a uniform distribution of stresses
structurally compromised due to a variety of reasons, along the post-dentin interface, thus avoiding critical
including caries, restorations, and endodontic access stress concentration and catastrophic fractures of the
interventions [1]. The loss of tooth structure involving root [15–18]. Prefabricated fiber posts are cemented
one or both marginal ridges or the loss of a facial/lin- with a dual cure luting agent. The thickness of the resin
gual wall of the tooth significantly increases the risk of cement used affects the strength of the restoration at the
fracture [2]. Root-filled teeth show a greater association post-dentin interface [19], thus suggesting the need for
with fractures as compared to vital teeth [3]. dowels that adapt to the canal anatomy and have a good
Determining the optimal type of post-endodontic intracanal fit.
restoration is influenced by the type of teeth and their Recently, custom-made fiber post and core systems
position in the arch, forces of occlusion, and the re- that employ polyethylene fibers (Ribbond fibers; Rib-
maining coronal tissue structure [4]. The quantity of the bond, Inc., Seattle, WA, USA) [20] have been introduced.
remaining tooth structure comprises the ferrule, which Ribbond is an ultra-thin, leno-weaved, high molecular
is defined as “a 360° collar of the crown that surrounds weight, reinforcement ribbon with excellent bondability
the parallel walls of the dentin and extends coronally to and fracture toughness. Ribbond fibers are embedded
the shoulder of the preparation” [5]. An abundance of in resin composite which are then condensed within the
literature demonstrates increased fracture resistance of canal in the form of an endodontic post [21]. Ribbond
endodontically-treated teeth in the presence of at least posts are said to be biologic posts with improved esthet-
1 mm of ferrule height [5–7]. When the coronal struc- ics and translucency, and relative ease of manipulation.
tural loss is greater than 50%, the literature suggests They can also be placed in a single visit without the
the placement of an intraradicular post to reinforce need for a laboratory phase [22].
structurally compromised teeth, increase their fracture Literature regarding the behavior and performance of
resistance, and support the final crown restoration [8]. Ribbond post and core systems in terms of their reten-
Posts do not directly increase the strength of endodon- tive ability, fracture strength, and fracture repairability
tically-treated teeth but rather they facilitate the core as compared to that of conventional post and core sys-
retention [9,10]. tems needs further evaluation. Thus, this systematic re-
Cast posts and cores have conventionally been em- view was undertaken to analyze the outcome of in vitro
ployed to reinforce pulpless teeth. Metal posts have studies comparing the fracture resistance and mode of
excellent rigidity and the ability to withstand loads failure of Ribbond post and core systems with that of
without undergoing deformation. They are resilient to other post and core systems.
axial stresses whose intensity is along the post’s axis.
However, they have poor stress distribution ability, and METHODS
they exhibit a concentration of forces at the root apex
[11,12] since they possess a high modulus of elasticity, The PRISMA (Preferred Reporting Items for Systematic
much different from that of dentin. This also holds true Reviews and Meta-Analyses) protocol for systematic re-
for other post and core systems with a high modulus of views and meta-analyses was undertaken and was reg-
elasticity, such as prefabricated zirconium or prefabri- istered on PROSPERO (CRD42023472726). Using the PI-
cated metal posts. Employing posts with an elastic mod- COS (Population; Intervention; Comparison; Outcome;
ulus closer to that of dentin reduces the chances of cat- Study Design) framework, a review question was com-
astrophic radicular fractures [13]. Other than biological posed as follows: “Does the use of a Ribbond post and
concerns, metal posts also present aesthetic problems, core system influence the fracture resistance and failure
especially in anterior teeth. modes of endodontically-treated permanent teeth as

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Ribbond posts vs other post systems

compared to those of other post and core systems?” Data extraction and synthesis
For all the selected studies, the following information
Search strategy was reported: authors, year, type of teeth, post type,
A comprehensive, systematic literature search was car- study groups, remaining tooth structure, evaluated out-
ried out using several electronic databases: MEDLINE/ comes, mean fracture strength, mode of failure, luting
PubMed, Google Scholar, and Cochrane Library. The agent used, thermocycling, fracture testing equipment
following keywords or terms were employed and ad- used, statistical analysis software used, and statistical
justed according to each database: ((Ribbond) OR (fiber tests performed. Studies with homogeneous study
reinforced composite) OR (polyethylene fiber)) AND populations were subjected to meta-analyses using a
((Post) OR (Dowel) OR (endodontically-treated teeth) fixed-effect model. Only if the heterogeneity was sub-
OR (post-core technique) OR (post and cores) OR (end- stantial (>50%) then a random-effect model was em-
odontic post)) AND ((fracture resistance) OR (fracture ployed.
strength)).
Assessment of heterogeneity
Eligibility criteria Assessment of heterogeneity was performed using the
The studies were selected based on the following inclu- Review Manager (RevMan) software (Cochrane Collab-
sion and exclusion criteria. oration, London, UK) [23]. The results were presented
as the standardized mean difference (SMD) with a 95%
1. Inclusion criteria confidence interval (CI). Heterogeneity was considered
• Studies published from 1990 to 2022 in peer-reviewed statistically significant if p < 0.05. The Cochran Q test
journals and the I2 inconsistency tests were also performed to as-
• Studies published in the English language sess the heterogeneity of the treatment effects. A general
• In vitro comparative studies between Ribbond post guide to interpreting the I2 test is as follows [24]: 0% to
and core systems and other post and core systems 40%, heterogeneity might not be important; 30% to 60%,
• Studies included endodontically-treated permanent may represent moderate heterogeneity; 50% to 90%,
teeth, restored with different types of post and core may represent substantial heterogeneity; 75% to 100%,
systems may represent considerable heterogeneity.

2. Exclusion criteria Quality assessment

• In vivo and ex vivo studies, animal studies, reviews, For risk of bias analysis, two separate reviewers were ap-
case reports, case series pointed to analyze each individual study. The domains
• Studies that did not include Ribbond post and the core used for the quality assessment were based on the
group reporting of items as per the modified CONSORT (Con-
• Studies that included indirect restorations solidated Standards of Reporting Trials) statement for in
vitro studies [25] which were: teeth size and form stan-
Screening and selection of studies dardization, teeth free of caries or restorations, sample
All the results obtained underwent title screening and size calculation, randomization of specimens, imple-
abstract screening based on the eligibility criteria. mentation of sequence generation, outcome, statistical
After the elimination of duplicates, full-text articles methods, standardized teeth preparation, standardized
were retrieved if screening data was inconclusive. Two and replicable methodology, material application mea-
researchers who were blinded to each other were ap- sures followed, blinded evaluation, complete results,
pointed to identify the studies meeting the eligibility and funding. When a study described a domain, it was
criteria. A third reviewer was appointed to eliminate any allotted ‘yes’ and if it failed to describe a domain ‘no
disagreements during the selection of studies between information’ was allotted. If 10 to 13 domains were de-
the two authors. scribed, the study was determined to have a low risk of

https://doi.org/10.5395/rde.2025.50.e5 3/19
 Ribbond posts vs other post systems

bias. If seven to nine domains were described, the study Records identified through Records identified through
was determined to have some concerns or a moderate database searching additional sources (n = 0)
risk of bias. If less than seven domains were described, a (MEDLINE/PubMed: 392,
Google Scholar: 141,

Identification
high risk of bias was reported.
Cochrane Database: 64)
(n = 597)
Investigation of publication bias
The presence of publication bias was assessed visually
by the relative symmetry of individual studies around Records after duplicates
the overall estimates using Begg’s funnel plot. The fun- were removed (n = 407)
nel plots were drawn of effect size versus standard error
for each subgroup analysis. Asymmetry of the funnel
Titles and abstracts Records excluded after
plots may imply publication bias. screened (n = 407) title/abstract screening

Screening
(n = 389)
RESULTS •A fter title screening
(n = 312)
•A fter abstract screening
Search strategy and characteristics of the studies
(n = 77)
A total of 597 records were obtained from searching
electronic databases. After the removal of duplicates, a Full text articles excluded,
Full text articles assessed
total of 407 records remained which were then subject- for eligibility (n = 18) with reasons (n = 6)
Eligibility

ed to title screening and abstract reading. A total of 389 • No intraradicular

records were excluded, and 18 articles underwent full- placement of Ribbond
text evaluation. Of those, 12 articles met the eligibility (n = 4)
• No comparative post
criteria and were included in the present systematic
group (n = 2)
review and underwent quality assessment and data
Studies included in
extraction. Meta-analysis was performed with 11 of the qualitative synthesis
12 studies included. The search strategy and process of (n = 12)
Included

study selection are reported in Figure 1 along with the

reasons for exclusion.
Studies included in
quantitative synthesis
Characteristics of included studies (meta-analyses) (n = 11)
The chief characteristics of the 12 studies included
are presented in Table 1. In comparison to Ribbond Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews
posts, all 12 studies tested prefabricated glass fiber and Meta-Analyses) flowchart showing search strategy and selec-
tion of studies.
posts [18,26–36], four studies tested custom glass fiber
(EverStick; GC Europe N.V., Leuven, Belgium) posts
[28,29,31,32], two studies tested cast metal posts [33,35], as a fracture at the original site/fracture at new sites [29].
four studies tested prefabricated metal posts [18,31–33], One study did not provide an adequate description of
and one study also tested zirconia and quartz post the fracture patterns [18]. Amongst the five composite
[27]. Nine of the 12 studies also assessed the fracture resin core studies, two studies described the fracture
patterns in which three studies tested reattached frag- pattern based on restorability as favorable/unfavorable
ment samples [29,32,36] whereas the other five studies [31] or repairable/nonrepairable [35], while the other
tested a composite resin core build-up [26,30,31,33,35]. three studies described the fracture pattern based on
Amongst the three reattached fragment studies, two fracture line propagation along the root [26,30,33]. Some
studies described the fracture patterns as repairable/ additional characteristics are also mentioned in Table 2.
nonrepairable [32,36] while the third study described it

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 Table 1. Main characteristics extracted from selected studies
of failure
Study (year) Type of teeth Post type Study group Remaining structure Evaluated outcome Mean Fracture strength Mode
(catastrophic)
Sirimai et al. Maxillary central incisors · Cast metal post · Group 1: CPC Decoronated at the level Fracture resistance and · Group 1 (CPC): 288.61 · Group 1: 100%
(1999) [33] (N = 60, n = 10) · Prefabricated metal · Group 2: VPT of the most incisal mode of failure ± 51.74 N · Group 2: 60%
post · Group 3: PWFH point of the CEJ · Group 2 (VPT): 254.70 · Group 3: 10%
· Polyethylene fiber post · Group 4: PWFH-VPT ± 55.66 N · Group 4: 40%
· Group 5: PWFH-PP · Group 3 (PWFH): 127.01 · Group 5: 20%
· Group 6: PP ± 26.85 N · Group 6: 80%
· Group 4 (PWFH-VPT):
218.34 ± 20.48 N
· Group 5 (PWFH-PP):
Ribbond posts vs other post systems

233.63 ± 42.92 N

https://doi.org/10.5395/rde.2025.50.e5
· Group 6 (PP): 201.39
± 29.1 N
Newman et al. Maxillary central incisors · Prefabricated glass fiber Control: Decoronated 2 mm Fracture resistance and
(2003) [18] (N = 90, n = 10) post · 1,4: Parapost XH 1.5 mm incisal to the CEJ of the mode of failure · 1,4: 18.33 ± 3.27 kg · 1,4: 30%
· Prefabricated metal Narrow canals: buccal surfaces
post · 1,1: Fiberkor fiber post · 1,1: 9.79 ± 1.29 kg
· Polyethylene fiber post 1.5 mm
· 1,2: 12.90 ± 1.64 kg · 1,1: 0%
· 1,2: Luscent fiber post
· 1,3: 4.55 ± 1.49 kg · 1,2: 0%
1.6 mm
· 1,3: Ribbond 1.6 mm · 1,5: 24.91 ± 11.53 kg · 1,3: 0%
· 1,5: Ribbond nonstan- · 1,5: 0%
dardized 2 mm
Flared canals:
· 2,1: Fiberkor fiber post · 2,1: 9.04 ± 1.76 kg
1.5 mm · 2,2: 12.87 ± 2.69 kg · 2,1: 0%
· 2,2: Luscent fiber post · 2,3: 12.87 ± 3.54 kg · 2,2: 0%
1.6 mm · 2,5: 31.95 ± 11.98 kg · 2,3: 0%
· 2,3: Ribbond 1.6 mm · 2,5: 0%
· 2,5: Ribbond nonstan-
dardized 2 mm
(Continued to the next page)

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 Table 1. Continued

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of failure
Study (year) Type of teeth Post type Study group Remaining structure Evaluated outcome Mean Fracture strength Mode
(catastrophic)
Ozcan and Maxillary canines · Prefabricated metal · Group 1: Titanium posts 2 mm above the buccal Fracture resistance and · Group 1: 521 ± 153 N No catastrophic
Valandro (2009) (N = 70, n = 10) post (ParaPost) + Silano-Pen CEJ mode of failure · Group 2: 525 ± 91 N fractures for
[31] · E-glass fiber post (Bredent) + silane · Group 3: 550 ± 149 N any group
· Polyethylene fiber post · Group 2: Titanium posts · Group 4: 408 ± 122 N
+ 30 μm CoJet-Sand · Group 5: 321 ± 131 N
(3M ESPE) + silane · Group 6: 267 ± 108 N
· Group 3: Titanium · Group 7: 175 ± 70 N
posts + 50 μm Al2O3 +
V-primer (Sun Medical)
· Group 4: Titanium posts
+ 50 μm Al2O3 + Alloy
primer (Kuraray)
· Group 5: E-glass FRC
post (EverStick)
· Group 6: Polyethylene
fiber (Ribbond) + resin
impregnation
· Group 7: Resin compos-
ite core only, with no
posts
Ozcopur et al. Single rooted teeth · Prefabricated metal Sound roots: control Decoronated keeping a Fracture resistance and Sound roots: control Sound roots:
(2010) [32] (N = 80, n = 10) post · Unicore root length of 12 mm mode of failure · Unicore: 1,472.78 ± control
· Prefabricated glass fiber · EverStick 195.29 N · Unicore: 80%
post · Ribbond · EverStick: 1,265.94 ± · EverstickEver-
· E-glass fiber post · Parapost 81.46 N Stick: 40%
· Polyethylene fiber post Reattached fragments · Ribbond: 976.74 ± · Ribbond: 0%
· Unicore 103.7 N · Parapost: 60%
· EverStick · Parapost: 1,342.29 ± Reattached
· Ribbond 370.13 N fragments
· Parapost Reattached fragments · Unicore: 58%
· Unicore: 1070.77 ± · EverstickEver-
178.42 N Stick: 47%
· EverStick: 1042.23 ± · Ribbond: 25%
147.06 N · Parapost: 68%
· Ribbond: 995.32 ±
88.75 N
· Parapost: 1318.3 ±
240.9 N
(Continued to the next page)

https://doi.org/10.5395/rde.2025.50.e5
Ribbond posts vs other post systems
 Table 1. Continued
of failure
Study (year) Type of teeth Post type Study group Remaining structure Evaluated outcome Mean Fracture strength Mode (catastrophic)
Aggarwal et al. Uni-radicular mandibu- · Cast metal post · Group I/CD: cast dowel Decoronated Fracture resistance and · Group I/CD: 484 ± 41 N · Group I/CD:
(2012) [35] lar premolar teeth · Prefabricated glass fiber · Group II/FD: single glass mode of failure · Group II/FD: 338 ± 28 N 90%
(N = 50, n = 10) post fiber dowel · Group III/AFD: 352 ± 34 · Group II/FD:
· Polyethylene fiber post · Group III/AFD: glass N 20%
fiber-reinforced resin · Group IV/DL: 368 ± 24 · Group III/AFD:
dowel with accessory N 30%
fiber dowels · Group V/RRR: 256 ± 22 · Group IV/DL:
· Group IV/DL: relined N 30%
glass fiber-reinforced · Group V/RRR:
Ribbond posts vs other post systems

resin dowel 0%

https://doi.org/10.5395/rde.2025.50.e5
· Group V/RRR: dowels
formed with the help
of polyethylene fiber
ribbon-reinforced resin
composite
Jindal et al. (2012) Maxillary incisors · Prefabricated glass fiber Control group Decoronated 2 mm Fracture resistance and Control: 437.87 ± 32.81 N Glass fiber post
[30] (N = 75, n = 15) post Glass fiber post above CEJ mode of failure Glass fiber post · 10 mm: 0%
· Polyethylene fiber post · 10 mm · 10 mm: 740.21 ± 29.87 · 5 mm: 30%
· 5 mm N Ribbond fiber
Ribbond fiber post · 5 mm: 425.18 ± 42.73 N post
· 10 mm Ribbond fiber post · 10 mm: 40%
· 5 mm · 10 mm: 216.93 ± 53.39 · 5 mm: 30%
N
· 5 mm: 299.62 ± 53.42 N
Kumar et al. Mandibular premolars · E-glass fiber post · Group 1: Only dual cure Decoronated root Fracture resistance and · Group 1: 181.26 ± 2.90 · Group 1: 73%
(2013) [29] (N = 60, n = 15) · Polyethylene fiber post resin cement length: 10 mm mode of failure N · Group 2: 0%
· Group 2: Ribbond · Group 2: 279.56 ± 0.80 · Group 3: 60%
· Group 3: EverStick N
(vertical fractures · Group 3: 224.09 ± 3.43
simulated in all three N
groups) · Group 4: 328.14 ± 1.06
· Group 4: Unfractured N
control group

(Continued to the next page)

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 Table 1. Continued

8/19
of failure
Study (year) Type of teeth Post type Study group Remaining structure Evaluated outcome Mean Fracture strength Mode (catastrophic)
Braga et al. (2015) Maxillary premolars · Prefabricated glass fiber · Group 1: sound teeth Class II MOD cavities,1m Fracture resistance and · Group 1: 0.83 ± 0.15 N · Group 1: 0%
[26] (N = 100, n = 10) post (positive control) above CEJ on both mode of failure · Group 2: 0.14 ± 0.05 N · Group 2: 50%
· Prefabricated polyfiber · Group 2: unrestored sides, with palatal ex- · Group 3: 0.43 ± 0.09 N · Group 3: 50%
post (negative control) tension cusps reduced · Group 4: 0.53 ± 0.07 N · Group 4: 40%
· Polyethylene fiber post · Group 3:MR to dimension 3 mm · Group 5: 0.41 ± 0.12 N · Group 5: 0%
· Group 4:FR+ MR thick and 3.5 mm in · Group 6: 0.48 ± 0.13 N · Group 6: 10%
· Group 5: glass fiber post height · Group 7: 0.50 ± 0.17 N · Group 7: 50%
(Reforpost) + MR · Group 8: 0.54 ± 0.14 N · Group 8: 10%
· Group 6: Reforpost + FR · Group 9: 0.79 ± 0.16 N · Group 9: 30%
+ MR · Group 10: 0.84 ± 0.11 N · Group 10: 20%
· Group 7:polyethylene
fiber (Ribbond) + MR
· Group 8: Ribbond + FR
+ MR
· Group 9: polyfiber post
(Spirapost) + MR
· Group 10: Spirapost +
FR + MR
Ramesh et al. Reattached maxillary · Prefabricated glass fiber Group 1: labiopalatal Group 1: 2 mm palatally, Fracture resistance and Group 1: Group 1:
(2016) [36] central incisor frag- post fracture 6 mm labially mode of failure · Subgroup 1: 568.4 ± · Subgroup 1:
ments (N = 60, n = 30) · Polyethylene fiber post · Subgroup 1: prefabricat- Group 2: 6 mm palatally, 18.65 N 20%
ed fiber post 2 mm labially · Subgroup 2: 519.7 ± · Subgroup 2: 0%
· Subgroup 2: Ribbond 22.36 N Group 2:
post Group 2: · Subgroup 1:
Group 2: palatolabial · Subgroup 1: 533.4 ± 13.3%
fracture 19.62 N · Subgroup 2: 0%
· Subgroup 1: prefabricat- · Subgroup 2: 488.1 ±
ed fiber post 34.41 N
· Subgroup 2: Ribbond · Subgroup 2: 488.1 ±
post 34.41 N

(Continued to the next page)

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Ribbond posts vs other post systems
 Table 1. Continued
of failure
Study (year) Type of teeth Post type Study group Remaining structure Evaluated outcome Mean Fracture strength Mode
(catastrophic)
Thakur and Mandibular first premo- · E-glass fiber post Post length 2/3rd of the Decoronated at CEJ, Fracture resistance · Subgroup 1A: 179.75 ± Not applicable
Ramarao (2019) lars (N = 90, n = 10) · Polyethylene fiber post canal: root length 15 mm 33.52 N
[34] · Subgroup 1A: custom · Subgroup 1B: 166.84 ±
polyethylene post 33.11 N
· Subgroup 1B: custom · Subgroup 1C: 250.33 ±
glass fiber post 15.40 N
· Subgroup 1C: prefabri- · Subgroup 1D: 201.39 ±
cated polyethylene post 41.44
Ribbond posts vs other post systems

· Subgroup 1D: prefabri-

· Subgroup 2A: 146.44 ±

https://doi.org/10.5395/rde.2025.50.e5
cated glass fiber post
13.53 N
Post length 1/2 of the
· Subgroup 2B: 159.97 ±
canal:
34.06 N
· Subgroup 2A: custom · Subgroup 2C: 224.2 ±
polyethylene post 32.9 N
· Subgroup 2B: custom · Subgroup 2D: 204.07 ±
glass fiber post 29.63 N
· Subgroup 2C: prefabri-
cated polyethylene post Control group: 57.34 ±
· Subgroup 2D: prefabri- 14.03 N
cated glass fiber post
Control group: core with-
out post
Khurana et al. Maxillary incisors · E-glass fiber post Group A: labiopalatal Labiopalatal: 2 mm Fracture resistance Group A: Not applicable
(2021) [28] (N = 60, n = 15) · Polyethylene fiber post fracture palatally, 6 mm labially · A1: 517.4 ± 72.0 N
· A1: Ribbond Palatolabial: 6 mm pala- · A2: 725.5 ± 59.6 N
· A2: EverStick tally, 2 mm labially
Group B: palatolabial Group B:
fracture · B1: 423.2 ± 80.5 N
· B1: Ribbond · B2: 617.0 ± 81.8 N
· B2: EverStick
Batra et al. (2022) Mandibularfirst premo- · Zirconia post · Group I: Zirconia post, Not mentioned Fracture resistance · Group I: 463.5 ± 14.3 N Not applicable
[27] lars (N = 48, n = 12) · Prefabricated glass fiber · Group II: Glass fiber post, · Group II: 425.2 ± 23.5 N
post · Group III: polyethylene · Group III: 410.4 ± 18.6
· Polyethylene fiber post -woven fiber posts, N
· Quartz post · Group IV: Quartz post · Group IV: 385.2 ± 14.2
N
The ‘N’ and ‘n’ in the “Type of teeth” column represent ‘the population size of the study’ and ‘the sample size per group,’ respectively.
CEJ, cementoenamel junction; CPC, cast post and core; FR, flowable resin; MOD, mesio-occluso-distal; MR, microhybrid resin; PP, Parapost Plus post; PWFH, polyethylene woven fiber/Helio-
bond resin; VPT, vario-passive titanium post.

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 Ribbond posts vs other post systems

Table 2. Additional characteristics extracted from selected studies

Material used to form Statistical
Fracture testing Statistical tests
Study (year) custom polyethylene Luting cement used Thermocycling analysis
equipment performed
fiber posts software
Sirimai et al. Variolink, Ivoclar · Group 1 and 2: Zinc Not performed Instron Universal SAS program · One-way ANOVA
(1999) [33] phosphate cement Testing Machine · Student Newman-
· Group 3, 4, 5 and 6: 4202 Keuls grouping
Variolink, Ivoclar · 2 × 2 chi-square
analysis
Newman et al. Flow-it, Pentron Clini- · 1,1; 1,2; 1,4: Cement-it, Pen- Not performed Instron Universal SYSTAT · Two-way ANOVA
(2003) [18] cal Technologies tron Clinical Technologies Testing Machine · ANOVA test
· 2,1; 2,2: Flow-it Self, Pentron 5655 · Independent
Clinical Technologies Student t-test
· 1,3; 1,5; 2,3; 2,5: Flow-it, · Tukey test
Pentron Clinical Technolo-
gies
Ozcan and Panavia F 2.0, Kuraray Panavia F 2.0, Kuraray Subjected to ther- Zwick ROELL Z2. SAS program · One-way ANOVA
Valandro mocycling for 6,000 5MA Universal · Tukey test
(2009) [31] cycles between 5° Testing Machine
and 55°C
Ozcopur et al. Variolink II, Ivoclar Variolink II, Ivoclar Not performed Instron Universal Not mentioned · One-way ANOVA
(2010) [32] Testing Machine · Independent t-test
Aggarwal et al. RelyX ARC, 3M ESPE · Group I/CD: Zinc phos- Not performed Zwick Instron Not mentioned · One-way ANOVA
(2012) [35] phate, SS White Universal Testing · Fischer exact test
· Group II/FD: RelyX ARC, 3M Machine
ESPE
· Group III/AFD: RelyX ARC,
3M ESPE
· Group IV/DL: Filtek Z350,
3M ESPE
· Group V/RRR: RelyX ARC,
3M ESPE
Jindal et al. Monocem, Shofu Monocem, Shofu Not performed LR 100 K digital SPSS version · One-way ANOVA
(2012) [30] Instron Universal 11.0 and post hoc test
Testing Machine
Kumar et al. RelyX U100, 3M ESPE RelyX U100, 3M ESPE Not performed Universal Testing Not mentioned · One-way ANOVA
(2013) [29] Machine · Tukey post hoc test
· Kruskall-Wallis and
Mann-Whitney test
Braga et al. RelyX ARC, 3M ESPE RelyX ARC, 3M ESPE Not performed Instron Universal SPSS version 17 · Kolmogorov-
(2015) [26] Testing Machine Smirnov test
4444 · One-way ANOVA
· Tukey post hoc test
Ramesh et al. ParaCore, Coltene ParaCore, Coltene Not performed Instron Universal Excel and SPSS · Student t-test
(2016) [36] Testing Machine · Chi-square test
Thakur and Luxa core Z, DMG Luxa core Z, DMG Not performed Hounsfield Univer- Not mentioned · One-way and two-
Ramarao sal Testing Ma- way ANOVA
(2019) [34] chine, S-series · Bonferroni adjust-
ment test
Khurana et al. Solocem, Coltene Solocem, Coltene Not performed Instron Universal SPSS version 23 · One-way ANOVA
(2021) [28] Testing Machine and post hoc test
Batra et al. Panavia F 2.0, Kuraray Panavia F 2.0, Kuraray Not performed Universal Testing SPSS · One-way ANOVA
(2022) [27] Machine · Bonferroni post
hoc test
ANOVA, analysis of variance.

10/19 https://doi.org/10.5395/rde.2025.50.e5
Ribbond posts vs other post systems

Risk of bias of included studies fracture resistance in endodontically-treated teeth with-

The risk of bias in the included studies is presented in out posts group. The analysis showed higher fracture
Table 3, along with the overall risk of bias presented in resistance in the Ribbond posts group.
Figure 2. All the included studies were largely compara- Figure 3B presents the subgroup analysis comparing
ble in methodological quality. All the included studies Ribbond posts with prefabricated metal posts; frac-
had a low risk of bias with all the respective domains. ture strength values were significantly higher with the
The highest risk of bias was seen for ‘sample size calcu- use of prefabricated metal posts (SMD, 1.81 [95% CI,
lation,’ ‘implementation of sequence generation,’ and 1.12–2.50]; I2 = 18%). Ozcan and Valandro [31], Ozcopur
‘blinded evaluation’ domains. As per the domains ana- et al. [32], and Sirimai et al. [33] showed higher fracture
lyzed, all studies presented a low risk of bias. resistance in the prefabricated metal posts group. The
analysis showed higher fracture resistance in the pre-
Results of meta-analysis fabricated metal posts group compared to the Ribbond
The meta-analysis of the review was performed on 11 posts group.
studies [26–36]. The meta-analysis of the included stud- Figure 3C presents the subgroup analysis comparing
ies evaluating the fracture strength values is presented Ribbond posts with prefabricated fiber posts; the use of
as forest plots in Figure 3. prefabricated fiber posts significantly increased the frac-
ture strength values (SMD, 1.42 [95% CI, 0.03–2.81]; I2
Fracture resistance = 91%). Aggarwal et al. [35], Batra et al. [27], Jindal et al.
Figure 3A shows the subgroup analysis comparing Rib- [30], Ozcopur et al. [32], Thakur and Ramarao [34], and
bond posts with endodontically-treated teeth restored Ramesh et al. [36] showed higher fracture resistance
without a post; the use of Ribbond posts improved the in the prefabricated fiber posts group. Braga et al. [26]
fracture strength values significantly (SMD, –6.45 [95% showed higher fracture resistance in the Ribbond posts
CI, –11.05 to –1.85]; I2 = 97%). Braga et al. [26], Kumar group. The analysis showed higher fracture resistance
et al. [29], Ozcan and Valandro [31], and Thakur and in prefabricated fiber posts compared to the Ribbond
Ramarao [34] showed higher fracture resistance in the posts group.
Ribbond posts group. Jindal et al. [30] showed higher Figure 3D shows the subgroup analysis comparing

■ Yes ■ No information
Teeth size and form standardization
Teeth free of caries or restorations
Sample size calculation
Randomization of specimens
Implementation of sequence generation
Outcome
Statistical methods
Standardized teeth preparation
Standardized and replicable methodology
Material application measures were followed
Blinded Evaluation
Completed results
“Funding had no influence”

0 2 4 6 8 10 12
Number of included studies describing the domain
Figure 2. Overall summary of the risk of bias assessment.

https://doi.org/10.5395/rde.2025.50.e5 11/19
 Table 3. Risk of bias assessment based on reporting of items according to the modified CONSORT guidelines for in vitro studies
Specimens’ set-up Randomization Materials and methods Evaluation and results

12/19
Material “Funding Risk
Study Teeth size and Teeth free Sample size Implementation Outcome Statistical Standardized Standardized application
calculation Randomization methods Blinded Complete had no of
form of caries or of sequence teeth and replicable measures
of specimens Evaluation results influence” bias
standardization restorations generation preparation methodology were
followed
Ramesh et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[36] mation mation
Ozcan and Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
Valandro mation mation
[31]
Braga et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[26] mation mation
Aggarwal et Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
al. [35] mation mation
Jindal et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[30] mation mation
Sirimai et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[33] mation mation
Ozcopur et Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
al. [32] mation mation
Newman et Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
al. [18] mation mation
Khurana et Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
al. [28] mation mation
Kumar et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[29] mation mation
Batra et al. Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
[27] mation mation
Thakur and Yes Yes No infor- Yes No information Yes Yes Yes Yes Yes No infor- Yes Yes Low
Ramarao mation mation
[34]
CONSORT, Consolidated Standards of Reporting Trials.

https://doi.org/10.5395/rde.2025.50.e5
Ribbond posts vs other post systems
Ribbond posts vs other post systems

A Study
ETT without post
Mean SD Total Mean
Ribbond
SD Total
SMD 95% CI Weight SMD

Braga et al. 2015 430 9 10 540 14 10 –8.95 [–12.17, –5.73] 21.3%

Jindal et al. 2012 437.87 32.81 15 299.62 53.42 15 3.03 [1.94, 4.13] 23.4%
Kumar et al. 2013 1,812 2.9 15 279.56 0.806 15 –44.97 [–57.19, –32.74] 8.9%
Ozcan et al. 2009 175 70 10 267 108 10 –0.97 [–1.91, –0.03] 23.5%
Thakur et al. 2019 57.34 14.03 10 179.75 33.5 10 –4.57 [–6.37, –2.76] 22.9%

Total (95% CI) 60 60 –6.45 [–11.05, –1.85] 100%

Heterogeneity Tau2 = 23.17; Chi2 = 138.01; df = 4 (p < 0.00001); I2 = 97% –50 0 50

Test for overall effect: Z = 2.75 (p = 0.006) Favor Favor ETT
Ribbond without post

B Prefabricated metal post Ribbond

Study SMD 95% CI Weight SMD
Mean SD Total Mean SD Total

Ozcan et al. 2009 521 153 10 267 108 10 1.84 [0.75, 2.92] 33.8%
Ozcopur et al. 2010 1,342.29 370.13 10 967.74 103.69 10 1.29 [0.30, 2.27] 39.4%
Sirimai et al. 1999 201.39 29.1 10 127.01 26.85 10 2.54 [1.30, 3.79] 26.8%

Total (95% CI) 30 30 1.81 [1.12, 2.50] 100%

–50 0 50
Heterogeneity Tau2 = 0.07; Chi2 = 2.43; df = 2 (p < 0.00001); I2 = 18% Favor Favor prefab-
Test for overall effect: Z = 5.11 (p = 0.30) Ribbond ricated metal
post

C Study
Prefabricated fibre post Ribbond
SMD 95% CI Weight SMD
Mean SD Total Mean SD Total

Aggarwal et al. 2012 338 28 10 256 22 10 3.12 [1.73, 4.51] 13.8%

Batra et al. 2022 452.2 23.5 12 410 18.6 12 0.69 [–0.14, 1.52] 15.2%
Braga et al. 2015 480 13 10 540 14 10 4.25 [–5.97, –2.54] 12.9%
Jindal et al. 2012 425.18 42.73 15 299.62 53.42 15 2.53 [1.53, 3.52] 14.8%
Ozcopur et al. 2010 1,472.78 195.3 10 976.74 103.7 10 3.04 [1.67, 4.41] 13.9%
Ramesh et al. 2015 568.4 18.65 15 533.4 19.62 15 1.78 [0.92, 2.64] 15.1%
Thakur et al. 2019 250.33 15.4 10 179.75 33.52 10 2.59 [1.34, 3.85] 14.2%

Total (95% CI) 82 82 1.42 [0.03, 2.81] 100%

Heterogeneity Tau2 = 3.15; Chi2 = 64.25; df = 6 (p < 0.00001); I2 = 91% –50 0 50

Test for overall effect: Z = 2.00 (p = 0.05) Favor Favor
Ribbond prefabricated
fibre post
D Study
Custom glass fiber post Ribbond
SMD 95% CI Weight SMD
Mean SD Total Mean SD Total

Khurana et al. 2021 725.5 59.6 15 517.4 72 15 3.06 [1.97, 4.16] 28.1%
Kumar et al. 2013 224.09 3.43 15 279.5 0.806 15 –21.64 [–27.56, –15.72] 15.9%
Ozcan et al. 2009 321 131 10 267 108 10 0.43 [–0.46, 1.32] 28.3%
Ozcopur et al. 2010 1,265.94 81.46 10 976.74 103.7 10 2.97 [1.62, 4.32] 27.7%

Total (95% CI) 50 50 –1.64 [–5.18, 1.89] 100%

Heterogeneity Tau2 = 11.26; Chi2 = 76.62; df = 3 (p < 0.00001); I2 = 96% –50 0 50
Test for overall effect: Z = 0.91 (p = 0.36)
Favor Favor
Ribbond custom glass
fiber post

Figure 3. Meta-analysis comparing fracture resistance of the Ribbond post (Ribbond, Inc., Seattle, WA, USA) groups and other experimental
groups. (A) Ribbond posts and endodontically-treated teeth (ETT) without posts. (B) Ribbond posts and prefabricated metal posts. (C) Ribbond
posts and prefabricated fiber posts. (D) Ribbond posts and custom e-glass fiber posts. CI, confidence interval; SD, standard deviation; SMD, stan-
dardized mean difference.

https://doi.org/10.5395/rde.2025.50.e5 13/19
 Ribbond posts vs other post systems

Ribbond posts with custom e-glass fiber posts; the use Publication bias
of Ribbond posts improved the fracture strength values No significant publication bias was reported according
significantly (SMD, –1.64 [95% CI, –5.18 to 1.89]; I2 = to the funnel plots generated on subgroup analysis us-
96%). Khurana et al. [28] and Ozcopur et al. [32] showed ing the random effects model presented in Figure 4.
higher fracture resistance in the custom glass fiber posts
group. Ozcan and Valandro [31] showed no difference DISCUSSION
between the two groups. Kumar et al. [29] showed high-
er fracture resistance in the Ribbond group. The analysis Teeth are susceptible to a variety of occlusal loads in the
showed higher fracture resistance in the Ribbond posts oral cavity during masticatory functions like chewing,
group compared to the custom glass fiber posts group. biting, and sometimes parafunctional habits [37]. End-
odontically-treated teeth are typically difficult to restore,
Mode of failure and when they involve significant tissue loss, intraradic-
Table 4 shows the fracture patterns and modes of failure ular reinforcements are sometimes required to keep the
of different post systems as compared to those of Rib- coronal restoration in place. This systematic review and
bond posts. As evident from the incidence rate of cata- meta-analysis comprised in vitro studies that assessed
strophic vs non-catastrophic fractures, Ribbond posts the placement of Ribbond posts as compared to other
consistently showed a favorable mode of fracture across intraradicular posts based on the fracture strength and
all the included studies. Cast metal posts showed the fracture patterns of structurally compromised endodon-
most unfavorable fractures followed by prefabricated tically-treated teeth.
metal posts, prefabricated glass fiber posts, and custom The amount of coronal structural loss a tooth experi-
e-glass fiber posts in decreasing order. ences dictates the type of post-endodontic restoration.

Table 4. Incidence rates of Modes of Failure (catastrophic vs non-catastrophic fractures) of Ribbond posts vs other post systems
Source % of non-catastrophic fractures (repairable/favorable)
Ribbond vs ETT without posts ETT without posts Ribbond posts
Ozcan and Valandro (2009) [31] 100% 100%
Kumar et al. (2013) [29] 27% 100%
Braga et al. (2015) [26] 100% 90%
Ribbond posts vs cast metal posts Cast metal posts Ribbond posts
Sirimai et al. (1999) [33] 0% 90%
Aggarwal et al. (2012) [35] 10% 100%
Ribbond posts vs prefabricated metal posts Prefabricated metal posts Ribbond posts
Sirimai et al. (1999) [33] 20% 90%
Newman et al. (2003) [18] 70% 100%
Ozcopur et al. (2010) [32] 40% 100%
Ribbond posts vs prefabricated glass fiber posts Prefabricated glass fiber posts Ribbond posts
Newman et al. (2003) [18] 100% 100%
Ozcopur et al. (2010) [32] 20% 100%
Aggarwal et al. (2012) [35] 80% 100%
Jindal et al. (2012) [30] 70% 70%
Braga et al. (2015) [26] 100% 90%
Ramesh et al.(2016) [36] 80% 100%
Ribbond vs custom e-glass fiber posts Custom e-glass fiber posts Ribbond posts
Ozcopur et al. (2010) [32] 60% 100%
Kumar et al. (2013) [29] 40% 100%
Braga et al. (2015) [26] 100% 100%
ETT, endodontically-treated teeth.

14/19 https://doi.org/10.5395/rde.2025.50.e5
Ribbond posts vs other post systems

SE (SMD) monoblock effect and thus dissipate the stresses along

0 the long axis of the tooth [41]. Without necessitating
structural alteration, Ribbond fibers can be cut and in-
0.2
corporated into dental composites. They adapt closely
0.4 to the internal contours of the tooth and remain ad-
hered to one another [40].
0.6 Traditionally, cast posts and cores have been em-
ployed due to their excellent strength and resistance
0.8 to deformation [44]. Cast posts provide an accurate fit,
SMD eliminating the need for a thicker layer of cement thus
1
–10 –5 0 5 10 contributing to its superior strength [44,45]. Likewise,
Figure 4. Begg’s Funnel plot with 95% confidence intervals demon- in the present systematic review and meta-analysis, it
strating symmetric distribution with the absence of systematic het- was seen that cast metal posts had a significantly higher
erogeneity of individual study compared with the standard error (SE) fracture strength when compared to Ribbond posts, but
of each study, indicating an absence of any publication bias. SMD, they resulted in catastrophic nonrepairable fractures. In
standardized mean difference.
the study by Sirimai et al. [33], it was seen that cast posts
had the highest fracture strength while polyethylene
According to Jotkowitz and Samet [38], the height and fiber posts had the lowest fracture strength, but there
thickness of the remaining ferrule along with the lateral was an unmistakable difference in the failure patterns
load a tooth undergoes directly affect the ‘risk of failure’ for both groups. All of the teeth restored by cast posts
and the quality of the restoration. Dietschi et al. [39] suffered nonrepairable root fractures; 90% had a vertical
recommended that weakened endodontically-treated root fracture pattern whereas 10% had a horizontal root
posterior teeth can be restored functionally and aesthet- fracture pattern at the junction of the middle and apical
ically by direct and indirect adhesive techniques, avoid- third of the root. Whereas, in the teeth restored with
ing an additional sacrifice of sound tissues and further polyethylene fiber posts only 10% of the samples expe-
stated that if there is less than half coronal residual tooth rienced a vertical root fracture and 80% of the samples
structure, post placement is indicated. The biomechan- had failure limited only to the composite core. Similar
ical properties of both, the remaining tooth structure findings were seen in the study by Aggarwal et al. [35],
and the material used for post and core, should be taken with the cast post group having the highest fracture
into consideration while restoring structurally compro- strength but nine out of 10 samples had a nonrepair-
mised teeth. able fracture pattern whereas the Ribbond post group
Recently, Ribbond posts (custom polyethylene fiber showed a repairable fracture strength for all samples de-
posts) have been used to restore weakened endodonti- spite having the lowest fracture strength. Similar results
cally-treated teeth [40]. Ribbond is made of leno-woven, were seen in the studies evaluating prefabricated metal
ultra-high molecular weight polyethylene fibers [41]. posts (titanium posts). Ozcan and Valandro [31] report-
Ribbond posts have several advantages over conven- ed that the fracture resistance of Paraposts (titanium
tional post and core systems such as improved esthet- posts; Coltene/Whaledent, Altstätten, Switzerland) was
ics, excellent bondability, and a modulus of elasticity almost twice that of Ribbond posts, with no unfavorable
very close to that of dentin [40]. Polyethylene fiber-re- fractures for either of the groups. The titanium post
inforced composites (FRCs) alter stress patterns, pro- group reported core fractures whereas the Ribbond post
viding improved stress distribution [42]. According to group reported a loss of post retention. The possible
a finite element analysis by Belli et al. [43], increased reason for this could be that during the fracture test per-
stress concentration was observed with an increase in formed in the study, loading was arrested the moment
the number of interfaces of the monoblocks created by core failure was observed and there was a high prob-
the restorations. Ribbond fiber posts create a primary ability of root fracture if loading had been continued.

https://doi.org/10.5395/rde.2025.50.e5 15/19
 Ribbond posts vs other post systems

Sirimai et al. [33] reported that although titanium posts ence on the biomechanical properties of the post and
have a higher fracture strength than Ribbond posts, core restoration. Furthermore, prefabricated fiber posts
90% of the posts fractured with a nonrepairable frac- require post space preparation which results in addi-
ture pattern, whereas only 10% of Ribbond posts had a tional root dentin removal, whereas custom fiber posts
nonrepairable fracture pattern. Ozcopur et al. [32] re- do not necessitate the need for root dentin removal
ported similar findings where despite a higher fracture since they adopt the canal anatomy [40].
strength, 60% of the posts fractured in a non-restorable With a deeper understanding of the biomechanics of
fashion whereas Ribbond posts exhibited 100% fracture the tooth system and improved material science and
repairability. This could be attributed to the material bonding protocols, aesthetic custom fiber posts have
properties that cast metal posts and prefabricated metal started coming into the limelight [28]. Custom FRC posts
posts exhibit, such as high stiffness, high modulus of adapt to the internal anatomy of the canal system. They
elasticity, and poor stress distribution ability with a crit- have a modulus of elasticity very close to that of dentin,
ical concentration of stresses apically [11,12]. Due to the which is advantageous due to excellent dissipation of
aforementioned properties, the posts tend to fracture at stresses, with reduced incidence of root fractures [32].
the expense of the root structure. Since custom fiber posts create a primary monoblock,
Prefabricated fiber posts have been gradually replac- stresses experienced during function and mastication
ing metal posts due to their improved aesthetic proper- get distributed more homogenously, thus avoiding criti-
ties, low modulus of elasticity, and greater dissipation cal stress concentration [32]. EverStick is a custom glass
of stresses [14]. Since fiber posts are prefabricated, a fiber post impregnated in unpolymerized resin which is
layer of luting cement surrounds the post, serving as the pliable and can be condensed into the canal in the form
weakest point of the tooth-post-core complex [19,46]. of a post [47]. In the present meta-analysis, EverStick
This creates a secondary monoblock as opposed to the posts showed marginally higher fracture strength than
primary monoblock that Ribbond posts provide, thus Ribbond posts. This could possibly be attributed to the
the stress dissipation is lesser than in custom-made fiber silanization of glass FRC posts which provides better
posts [43]. The advantage of having primary monoblock adherence of the glass fibers to the resin, whereas the
over secondary monoblock is that the homogeneity of inherent difficulty to achieve silanization with polyeth-
the tooth-post-core complex achieved in the former is ylene fibers leads to somewhat weaker adherence with
greater, thus opposing forces as a single unit [43]. All the resin [28]. However, the mode of failure evaluation
studies comparing prefabricated fiber posts with Rib- of EverStick posts when compared to Ribbond posts
bond posts in the present meta-analysis showed that revealed that Ribbond posts have a higher fracture re-
the former had a fracture resistance greater than that of pairability than EverStick posts. This could be attributed
the latter. The mode of fracture analysis revealed that to the differences in fiber orientation and intracanal ad-
in four out of the five studies [32,34–36], Ribbond posts aptation. EverStick posts are unidirectional and congre-
had 100% fracture repairability whereas in one study gate in the middle of the post space with a layer of resin
[30] the fracture repairability was 75%. Prefabricated cement around them, whereas polyethylene fibers are
fiber posts had a fracture repairability of 80% or less in multidirectional and show close adaptation to the canal
all studies, with one study showing fracture repairability wall, minimizing the resin cement interface, possibly
even as low as 60%. Although prefabricated fiber posts resulting in variations in the mode of failure [29].
have higher fracture resistance than Ribbond posts, the Ribbond posts also present some added advantages
fracture mode is not exceedingly favorable, resulting in over prefabricated fiber posts. Erkut et al. [48] studied
nonrepairable root fractures significantly more often the microleakage in overflared canals restored with
than Ribbond posts. Depending on the thickness of the adhesively luted posts and stated that Ribbond had the
cement layer, a large portion of the prefabricated fiber least amount of microleakage. Furthermore, custom
post and core restoration comprises the luting cement. Ribbond fiber posts have no shape memory and thus do
Thus, the quality of the luting cement has a direct influ- not experience a “rebound” phenomenon once placed

16/19 https://doi.org/10.5395/rde.2025.50.e5
Ribbond posts vs other post systems

in the canal, whereas prefabricated glass fiber posts of the present systematic review, although Ribbond
exhibit a significant memory and tend to revert to their posts have less fracture resistance when compared to
original “straight” position. This gives Ribbond posts an other contemporary post and core systems, they present
edge while being placed in curved canals [49]. the most favorable mode of failure. The fracture mode is
Clinical studies evaluating the survival rates of Rib- almost never at the cost of the tooth-core-post complex,
bond posts are scarce. Despite having lower fracture resulting in repairable non-catastrophic fractures. This
resistance values, clinical survival rates of Ribbond makes Ribbond posts a suitable biomimetic restorative
posts have been promising, as seen in a clinical study alternative for rehabilitating structurally compromised
performed by Piovesan et al. [50] which reported high teeth.
survival rates of Ribbond posts after the 97-month fol-
low-up period. This suggests that Ribbond posts may be CONFLICT OF INTEREST
advocated for long-term restorations. No potential conflict of interest relevant to this article
Besides their lower fracture resistance, Ribbond posts was reported.
also present another discernible drawback. They trans-
fer stresses to the cervical third of the root [32], which FUNDING/SUPPORT
could affect the retention of the post when there is a lack None.
or absence of ferrule. The primary purpose of intrara-
dicular post placement is not just retention of the core AUTHOR CONTRIBUTIONS
but to prevent the dislodgement of the tooth-core-post Conceptualization, Formal analysis, Project administra-
complex from the root at a level that is non-restorable tion: Vartak MA, Fanibunda U. Data curation, Funding
[51]. When teeth are severely structurally compromised, acquisition: Vartak MA. Investigation: Vartak MA, Heg-
with a ferrule of less than 2 mm, the need for a biologic de SR, Fanibunda U. Methodology: Vartak MA, Hegde
post that does not compromise the tooth structure fur- SR. Resources, Software, Visualization: Vartak MA, Fan-
ther or cause catastrophic failures is essentially height- ibunda U. Supervision: Fanibunda U, Hegde VR. Valida-
ened. Nilavarasan et al. [52] conducted a study on pri- tion: Fanibunda U. Writing - original draft: Vartak MA.
mary teeth with the remaining ferrule of only 1 mm and Writing - review & editing: Vartak MA, Fanibunda U. All
stated that Ribbond posts had a better fracture strength authors read and approved the final manuscript.
than prefabricated glass fiber posts. Further studies
should be undertaken to evaluate the role of Ribbond DATA SHARING STATEMENT
posts in restoring severely structurally compromised The datasets are not publicly available but are available
teeth, with inadequate ferrule. from the corresponding author upon reasonable re-
Although in vitro studies provide better standard- quest.
ization in terms of sample preparation and evaluation,
well-designed randomized clinical trials with a long REFERENCES
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