The restoration of endodontically treated teeth (ETT) has been extensively studied, yet remains controversial regarding their biomechanical integrity, failure patterns, and long-term clinical outcomes [[1], [2], [3]]. The vitality, structure and integrity of teeth are influenced by caries, multiple repeat restorations and fractures [4]. Endodontic treatment aims to improve the prognosis of compromised teeth, with reported long-term survival rates ranging from 86 % to 93 % over 2–10 years, depending on the restorative approach and patient factor [5,6]. Although some studies have suggested that endodontically treated teeth may have similar structural performance to vital teeth when adequately restored[7] it is generally accepted that teeth are weakened by endodontic procedures designed to provide optimal access and by the restorative procedures necessary to rebuild the tooth. Additionally, the loss of inherent dentinal fluid can alter tooth properties [8]. Consequently, ETT are more susceptible to fracture than vital teeth, emphasizing the importance of preserving as much dentin as possible and ensuring the presence of a continuous ferrule of at least 2 mm of circumferential coronal dentin when restoring these teeth [9,10].

When ETT exhibit extensive coronal structure loss, post-retained restorations may be indicated [11]. However, despite their advantages, these restorations are prone to mechanical failure after a period in clinical service including post decementation, post fracture or catastrophic root fracture [[12], [13], [14], [15]]. Furthermore, failure may occur because of poor post design, recurrent caries, periodontal disease or recurrent periapical pathology [16,17].

Various post-and-core systems have been developed to provide retention for coronal restorations [[18], [19], [20]]. Cast posts and cores offer a customized fit but require multiple appointments, while prefabricated metal posts allow for same-day completion but may not always conform precisely to the post space [21,22]. Fiber-reinforced composite posts, particularly those made of carbon or glass fibers, have a modulus of elasticity (approximately 20 GPa) similar to dentin (18 GPa), potentially improving stress distribution and reducing catastrophic root fracture risk [3,[23], [24], [25]]. Other post types include zirconium-coated carbon fiber, glass, or quartz fiber-reinforced resin composite, woven-fiber composite and zirconia posts [26,27]. In addition, CAD/CAM technology has enabled the fabrication of custom-made fiber-reinforced composite and zirconia posts, offering improved adaptation to the canal anatomy and potentially enhancing clinical outcomes [28].

The survival rates of post-retained restorations vary widely. Retrospective studies report survival rates between 89 % to 93 % over approximately 7–10 years [18,29], while prospective studies showed survival rates ranging from 67 % to 94 % over 7–8 years [30,31]. A meta-analysis reported an overall survival rate of 92.8 % for glass fiber posts, with the average time to extraction for post-and-core restorations being approximately 11.74 years [32,33].

Beyond clinical longevity, patient satisfaction is a key consideration in restorative dentistry. The appearance, function and overall integrity of restorations are major concerns for patients, but satisfaction is highly subjective and varies among individuals [34,35]. Clinical evaluations should consider both technical performance and patient-reported outcomes. Additionally, issues such as recurrent caries, gingivitis, or periodontal disease may influence clinical assessments and patient perceptions of restoration quality [36,37]. Clinical evaluations and patient satisfaction with direct and indirect restorations are influenced by multiple variables and parameters and agreements between these evaluations may vary [35,37].

Although numerous radiographic studies have extensively assessed teeth restored by the post-retained crowns [12,38,39], limited research has explored their clinical performance in terms of marginal adaptation, retention, patient-reported outcomes, and long term functionality. Furthermore, patient satisfaction with these restorations remains an area requiring further research.

This study aimed to evaluate the clinical performance of post-retained restorations through clinical assessments and patient-reported outcomes, focusing on the following objectives:1.

Assess the prevalence of post-retained crown restorations within a specific patient subpopulation.

2.

Identify patient-reported problems related to post-retained restorations.

3.

Compare clinical and patient evaluations by determining the percentages of restorations classified as satisfactory or unsatisfactory.

4.

Analyze factors affecting clinical performance and patient satisfaction with post-retained crowns.

The null hypotheses for this study were as follows:1.

No significant difference exists between the percentage of restorations classified as satisfactory by clinical evaluations and those classified as satisfactory by patient assessments.

2.

The quality of post-retained restorations is not significantly influenced by the variables examined.