Physicomechanical Properties of Tertiary Monoblock in Endodontics: A Systematic Review and Meta-analysis

INTRODUCTION: A systematic review and meta-analysis were conducted to evaluate the physicomechanical properties of tertiary monoblock obturation with different obturation techniques. METHODS AND MATERIALS: PubMed (MEDLINE), Web of Science, Scopus, the Cochrane Library, LILACS, IBECS, and BBO were searched time. PICO question was: “In extracted human teeth (Population), does tertiary monoblock obturation (Intervention) have superior physicomechanical properties (Outcome) compared to conventional obturation systems (Comparison)?”. Statistical analyses for push-out bond strength were performed with RevMan software by comparing the mean differences of each study, with a 95% confidence interval. Inverse variance was used as statistical method, random-effects models as analysis model, and heterogeneity between studies was assessed by Cochran’s Q test and I(2) statistic (P <0.05). RESULTS: Of 2162 studies retrieved, 31 were included in this review for “Study Characteristics”. Ten studies were included in the meta-analysis. Analysis demonstrated that conventional obturation had significantly higher push-out bond strength than tertiary monoblock obturation (P <0 .01), with a mean difference of −1.00 (95% CI, −1.41 to −0.58; I(2)=100%). Subgroups using single-cone and cold lateral condensation techniques showed significantly lower push-out bond strength for tertiary monoblock obturation (P <0.01), respectively with a mean difference of −0.09 (95% CI, −1.13 to −0.67; I(2)=97%) and of −1.97 (95% CI, −3.19 to −0.75; I(2)=100%). The warm vertical compaction subgroup showed no statistically significant difference between tertiary monoblock and conventional systems (P =0.13), with a mean difference of 0.49 (95% CI, −0.14 to 1.12; I(2)=10%). CONCLUSION: Tertiary monoblock systems have a push-out bond strength similar to conventional systems when used with warm vertical compaction.