AbstractAim  To assess survival rates and complications of root‐filled teeth restored with or without post‐and‐core systems over a mean observation period of ≥4 years.Methodology  A total of 325 single‐ and multirooted teeth in 183 subjects treated in a private practice were root filled and restored with either a cast post‐and‐core or with a prefabricated titanium post and composite core. Root‐filled teeth without post‐retained restorations served as controls. The restored teeth served as abutments for single unit metal‐ceramic or composite crowns or fixed bridges. Teeth supporting cantilever bridges, overdentures or telescopic crowns were excluded.Results  Seventeen teeth in 17 subjects were lost to follow‐up (17/325: 5.2%). The mean observation period was 5.2 ± 1.8 (SD) years for restorations with titanium posts, 6.2 ± 2.0 (SD) years for cast post‐and‐cores and 4.4 ± 1.7 (SD) years for teeth without posts. Overall, 54% of build‐ups included the incorporation of a titanium post and 26.5% the cementation of a cast post‐and‐core. The remaining 19.5% of the teeth were restored without intraradicular retention. The adjusted 5‐year tooth survival rate amounted to 92.5% for teeth restored with titanium posts, to 97.1% for teeth restored with cast post‐and‐cores and to 94.3% for teeth without post restorations, respectively. The most frequent complications included root fracture (6.2%), recurrent caries (1.9%), post‐treatment periradicular disease (1.6%) and loss of retention (1.3%).Conclusion  Provided that high‐quality root canal treatment and restorative protocols are implemented, high survival and low complication rates of single‐ and multirooted root‐filled teeth used as abutments for fixed restorations can be expected after a mean observation period of ≥4 years.