To compare intra-orifice barrier (IOB) materials for reinforcing endodontically treated teeth (ETT) using a network meta-analysis (NMA) of in-vitro studies.

EBSCO, PubMed, Virtual Health Library, Ovid, Web of Science, Scopus, Cochrane Library and Google Scholar were searched to December 2025. Eligible studies compared at least two of the following: alkasite restorative material, composite resin, fiber-reinforced composite (FRC), resin-modified glass ionomer cement (RMGIC), flowable composite, Biodentine, mineral trioxide aggregate (MTA), and control. The primary outcome was fracture resistance (Newtons). The analysis was conducted in MetaInsight v6.4.0 using its Bayesian option; results are reported as 95% credible intervals (CrI). Treatment hierarchy was summarized with SUCRA. Small-study effects were assessed with funnel plot and Egger’s test.

Twenty studies met the eligibility criteria; 14 contributed to the NMA. Versus control, fracture resistance increased with alkasite restorative material (MD 406.37; 95% CrI 133.4-679.8), FRC (MD 370.83; 95% CrI 168.82- 574.27), composite resin (MD 360.62; 95% CrI 181.92-555.15), RMGIC (MD 310.82; 95% CrI 180.93–449.62), flowable composite (MD 285.5; 95% CrI 107.79-468.35) and Biodentine (MD 230.83; 95% CrI 66.55–401.34). MTA showed no clear benefit (MD 60.41; 95% CrI -123.08- 242.82). SUCRA ranking favored alkasite restorative material, followed by FRC, composite resin, RMGIC, flowable composite resin,Biodentine, MTA, and control. Node-split analyses indicated some local inconsistency across a subset of contrasts (2/28 contrasts; minimum p= 0.003). Funnel-plot inspection and Egger’s test did not suggest small-study effects (p=0.664).

Use of an IOB generally improves the fracture resistance of ETT. Materials traditionally categorized as restorative materials (alkasite, resin composites, FRC, RMGIC) tended to rank higher than calcium silicate–based barriers (Biodentine, MTA) in vitro. Standardized testing protocols are needed to optimize material selection.