A retrospective clinical evaluation of direct and indirect aesthetic restorations with cuspal replacement

Abstract

Introduction: The increasing demand for aesthetic restorations had enabled new treatment choices to restore posterior teeth with extensive cavities. The treatments of these teeth involve direct composite restoration or indirect onlays, made with ceramic or composite. However, clinical data on the longevity of cuspal restorations comparing direct and indirect techniques and the restorative materials are rare. Purpose: To perform a retrospective clinical evaluation of direct restorations (composite resin) and indirect restorations (composite resin and ceramics) with cuspal involvement, using the FDI criteria. Materials and Methods: 229 restorations were evaluated in 121 patients (37 men and 84 women) who received at least one direct composite restoration with involvement of at least one cusp or ceramic/composite onlays among the years 2003 and 2016. The visual evaluation was done by an examiner previous calibrated by Cohen’s Kappa coefficient, using the FDI criteria. Data were analyzed by Kaplan-Meier, multivariated Cox regression analysis and Kruskal-Wallis test (p<0.05). Results: Among the evaluated restorations, 69 failures were detected. The average evaluation time was 4.3 years. Restorations achieved a survival rate of 69.9%, with annual failure rate (AFR) of 8.0%. Direct composite restorations presented 34.1% of failure, with AFR of 9.6%. Composite onlays presented 27.3% of failure, with AFR of 7.1%. Ceramic onlays showed a 28.8% failure rate with AFR of 7.6%. Restorations in men have failed more than in women. The most common reason for failure was fracture of the material and retention, occurring in 48 cases (69.56% of the failures). Conclusion: Direct and indirect restorations showed similar longevity, regardless of the number of cusps involved. Indirect restorations had lower annual failure rate than direct restorations, presenting better performance in the qualitative analysis. Female patients presented lower risk of failure, and the most prevalent type of failure in restorations with cusp involvement was fracture and retention.