Clinical Outcomes and Complication Rates of Crown Restorations with Various Endodontic Posts: A Retrospective Analysis

Objective: This retrospective study was conducted to evaluate long-term outcomes lcomplication rates of crown restorations supported by different types of endodontic posts and to determine the influence of post material on biological and technical outcomes. Materials and Methods: Clinical and radiographic data from 437 crowned teeth retained by fiber, metallic, or custom-made posts were collected at Qassim University Dental Hospital between August and November 2025. Biological (secondary caries, periapical lesions) and technical (debonding, fracture, chipping) complications were recorded. Kaplan–Meier and life-table analyses were used to estimate complication-free survival, and Cox regression was employed to identify significant predictors (α = 0.05). Results: The mean observation period was 6.76 ± 4.88 years. The overall complication rate was 56.8%. Crowns restored with fiber posts exhibited the lowest complication rate (40.0%) and the highest 15-year cumulative survival (52%), followed by custom-made (38%) and metallic posts (15%). Fiber posts demonstrated a significantly lower hazard of complications than metal posts (HR = 1.70, p = 0.009). Female sex (HR = 1.69, p = 0.001) and mandibular location (HR = 1.36, p = 0.048) were associated with increased risk. Metal–ceramic crowns showed a protective effect compared to ceramic crowns (HR = 0.56, p = 0.001). Conclusions: The type of post significantly affected long-term prognosis of crowned endodontically treated teeth. Fiber posts provided the most favorable outcomes by minimizing catastrophic root fractures, while metallic and custom-made posts demonstrated higher complication hazards. Crown material, arch location, and patient factors further influenced survival outcomes.