Objectives: The aim was to explore the survival of extensively damaged anterior teeth without ferrule restored with different fiber-reinforced composite (FRC) post-core foundations and composite crowns.

Materials and methods: Sixty extracted upper central incisors were decoronated and randomly divided into four groups (n = 15). After endodontic treatment, the specimens were restored with different individualized fiber-reinforced post-core foundations as follows: control group (CTRL): multiple unidirectional FRC-post + dual-cure composite-core, PFC: multiple unidirectional FRC-post + packable short fiber-reinforced composite (SFRC), BPFC: Bioblock technique with only packable SFRC, BFFC: Bioblock technique with only flowable SFRC. After core build-up, the teeth were finalized with adhesively luted CAD/CAM composite crowns. Cyclic isometric loading (5 Hz) was applied at 100 N for 5000 cycles, and then 200 N and 300 N for 15,000 cycles each in a fluid chamber. The specimens were loaded until fracture occurred or when a total of 35,000 cycles were reached. Kaplan-Meyer survival analysis was conducted, followed by pairwise log-rank post hoc comparisons (Mantel-Cox).

Results: The survival rates of the control (8279 cycles) and PFC (6161 cycles) were significantly higher compared to BPFC (3223 cycles) and BFFC (2271 cycles) (p < 0.05). Regarding fracture pattern, nearly all specimens fractured in a restorable manner.

Conclusions: For restoring extensively damaged anterior teeth, multiple unidirectional FRC posts are recommended.

Clinical relevance: Although different FRC post/core systems are available for the restoration of damaged root canal treated anterior teeth, multiple unidirectional FRC posts tend to be a good option when the ferrule is missing.