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20 February 2019

Partial VS complete coverage restorations

Lorenzo Breschi

The decision between complete or partial coverage restorations has always been much of an hamletic question in the clinical daily practice.
Is always better to adopt a more conservative action or could it be recommended to sacrifice tooth structure aiming to a more reliable restoration? A systematic review published on the Journal of Oral Rehabilitation, aiming to dissolve the controversial and extensively discussed concern about the indirect restoration of a single tooth, analysed the survival rates, as well as different biological and technical complications of diverse types of indirect restorations. 

The authors reviewed, after an electronic search in several database of various articles published between 1980 and 2017, 2849 papers. After a detailed assessment for eligibility, 9 studies were selected for inclusion. 

Evaluating a mere mean of the different survival rate founded in the 9 studies, inlays had a 90.89% 5yr survival rate, while for onlays and crowns it was 93.50% and 95.38% respectively.
Unfortunately the heterogeneity of the studies allow neither a meta-analysis nor any meaningful comparison between types of restorations or materials. Moreover, important aspect of the patients like parafunctional habits or different characteristics of the restorations like the ceramic or the luting agent used weren’t take into consideration among the 9 studies.   In the systematic review, failures were grouped as either biological or technical. Statistical analysis demonstrated caries to be the main biological complication for all types of restorations, followed by a root and/or tooth fracture incidence and endodontic incidence. Ceramic fractures represented the most common technical complication, followed by loss of retention and porcelain chipping.

The authors conclude that the 5 year survival rate for crowns and inlays/onlays is very high, exceeding 90%.
Recurrent decay, endodontic reasons and tooth fractures were the most frequent biologic complications and that ceramic fractures and core failures were the most frequent prosthetic complications.

For additional informations: 
Complications and survival rates of inlays and onlays vs complete coverage restorations: A systematic review and analysis of studies

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