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Title Direct Resin Composite Restorations on Posterior Teeth Requiring Cusp Replacement Have a Similar Success Rate to Indirect Resin Composite Restorations
Clinical Question How effective are direct resin composite restorations on posterior teeth requiring cuspal coverage when compared to indirect techniques?
Clinical Bottom Line In patients with posterior teeth requiring cusp replacement, direct resin composite restorations show similar efficacy to indirect resin composite techniques. This is supported by a Randomized Control Trial in which there was no significant difference in the five-year survival rates of vital maxillary premolars receiving direct or indirect resin composite restorations to replace a cusp. While the placement of direct resin composite restorations is technique sensitive, it is well within the capability of the average dental practice. The direct technique is less invasive, requires fewer appointments and is less expensive than the indirect technique.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24155264Fennis/2013157 patients (176 restorations) with Class II lesions in vital maxillary premolars with one missing cusp.Randomized Controlled Trial
Key results92 direct and 84 indirect restorations were placed with a mean follow-up time of 5.6 years for the direct technique and 6.0 years for the indirect technique. Although the direct restorations had a higher five-year survival rate than the indirect technique [89.9% (SE 0.34%) vs. 83.2% (SE 0.42%) for repairable failure and 91.2% (SE 0.32%) vs. 83.2% (SE 0.42%) for complete failure], the differences were not considered significant (reparable failure p=.23, 95% CI = -5.1 to 18.5%; complete failure p=.12, 95% CI= -3.6 to 19.6%).
Evidence Search (direct[All Fields] AND composite[All Fields] AND cusp[All Fields] AND restorations[All Fields]) OR (cuspal[All Fields] AND ("AHIP Cover"[Journal] OR "coverage"[All Fields]))
Comments on
The Evidence
Validity: The Fennis study was a Randomized Control Trial involving 157 patients. The groups were similar at start and were treated the same. The restorations were placed by two operators following a strict protocol. The treatment technique (direct or indirect) and operator were assigned randomly. The study had adequate follow-up and an 89.8% completion rate. Due to the nature of the study, it was not possible for this study to be double blind. There were no competing interests in this study. Perspective: It should also be noted that the direct resin composite restoration is technique sensitive.
Applicability This study has great applicability to all patients requiring cuspal coverage on posterior teeth. The direct resin composite technique is minimally invasive and only requires one appointment for placement. Another potential benefit of this technique is that repairs may be performed when necessary. While the treatment is technique sensitive, it can be done successfully by simply following the directions of the manufacturer and good isolation. This treatment provides an esthetic result and as the mechanical properties of resin composites continue to advance, the treatment option should become more and more popular.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Direct Resin Composite; Indirect Resin Composite; Cusp replacement; Cuspal coverage
ID# 2642
Date of submission: 02/25/2014spacer
E-mail furmana@uthscsa.edu
Author Adam Furman
Co-author(s) e-mail
Faculty mentor/Co-author William F. Pierpont, DDS
Faculty mentor/Co-author e-mail pierpont@uthscsa.edu
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