Post removal techniques: a systematic review and meta-analysis

Aim: This systematic review aimed to answer what is the best way to remove prefabricated metallic, fiber or cast metal posts.  Methodology: An electronic search was conducted in Medline and Scopus databases to identify clinical and in vitro studies that assessed post removal techniques from 1950 to October 2018. Tables were generated to summarize the included studies and reports were assessed for bias using the Cochrane risk of bias tool. A meta-analysis was performed to evaluate the force necessary to remove posts (α=5%).  Results: Of the 2,951 studies identified in the initial search, 33 were selected. The duration of using ultrasonic vibrations (and the number of surfaces where the vibration was applied) led to less time spent and less force needed to dislodge a metal post. Dentist’s expertise (more than 10 years) was also related to easier post removal. The use of adhesive cements resulted in a more difficult protocol for post removal.  Conclusions: Although there is need for more consistent results, the data summarized and meta-analysis points toward the use of ultrasonic energy as the first option to remove posts, with best results for metal posts.