13 December 2023

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Do direct and indirect reconstructions have the same clinical longevity? 

Lorenzo Breschi

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Resin composite materials are commonly used to perform direct restorations. Improvements in their mechanical and esthetic properties have characterized the last decade. Nevertheless, resin composite restorations still fail, mainly due to secondary caries and fractures. Alternatively, indirect resin composite restorations have been increasingly used to mitigate the drawbacks of direct technique and to prolong the lifespan of restorations. Recently, Josic et al have conducted a systematic review and meta-analysis in order to answer to the PICO(S) question: “Is there a difference in clinical longevity between direct and indirect resin composite restorations placed on permanent posterior teeth?”

Materials and methods

This systematic review was performed by following the preferred reporting item for systematic reviews and meta-analyses (PRISMA) guidelines and registered in PROSPERO. Randomized controlled clinical trials (RCTs) enrolling adult patients were considered with Class I or Class II cavities (regardless of cusp involvement) that required restoration due to tooth decay and/or failing of pre-existing restoration, including patients with tooth wear. The literature search was performed without any limitations, using Clarivate Analytics’ Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL). Furthermore, OpenGray, Google Scholar and other available digital repositories were used to best complete the research. 

Results

From the 3946 articles initially selected, only 23 were included in the systematic review, and only 8 studies were considered suitable for the meta-analysis. The studies were published between 1994 and 2023. In total, 731 adult patients received 789 direct and 801 indirect restorations placed on posterior teeth. No statistically significant differences (p>0.05) between direct and indirect resin composite restorations placed on posterior teeth at short-, medium- and long-term follow-ups were observed.

Conclusions

The purpose of this paper was to systematically review the literature and assess the differences in clinical longevity between direct and indirect resin composite restorations placed on posterior permanent teeth. Direct and indirect resin composite restorations showed similar clinical longevity for short-, medium- and long-term observation periods on permanent posterior teeth that were not affected by wear, even though low certainty of evidence was assessed. The observed quality of evidence suggests that more long-term RCTs are needed to confirm the findings of this systematic review 

For more information: Clinical longevity of direct and indirect posterior resin composite restorations: An updated systematic review and meta-analysis. Dental Materials, Volume 39, Issue 12, 2023, Pages 1085-1094, ISSN 0109-5641. U. Josic, C. D’Alessandro, V. Miletic, T. Maravic, C. Mazzitelli, J. Jacimovic, R. Sorrentino, F. Zarone, E. Mancuso, A. HS Delgado, L. Breschi, A. Mazzoni.

Source: https://doi.org/10.1016/j.dental.2023.10.009