Indirect Composite Restorations Research Articles

The influence of finishing line and luting material selection on the seating accuracy of CAD/CAM indirect composite restorations

ObjectivesThis study aimed to assess the seating accuracy of resin composite CAD/CAM overlay restorations, employing various preparation designs and luting materials (pre-heated composite (HC) or resin cement (RC)). MethodsA human molar's STL file was utilized to create 100 3D-printed resin tooth replicas, randomly distributed into 5 groups (n = 20) based on finishing line preparation designs: 1) Rounded shoulder above the dental equator - DE (SA); 2) Chamfer above the DE (CA); 3) Butt joint above the DE (BJ); 4) Rounded shoulder below the DE (SB); 5) Chamfer below the DE (CB). Digital impressions were acquired for all replicas, and restorations milled using Tetric CAD (Ivoclar Vivadent). The restorations were luted with HC (Tetric Prime, Ivoclar Vivadent) or RC (RelyX Universal, 3 M). Seating accuracy was evaluated through digital scans during try-in without any luting agent and post-cementation using a 3D analysis software (Geomagic wrap, 3D Systems). Data were statistically analyzed using Two-Way ANOVA (p < 0.05). ResultsThe type of luting material (RC vs HC), preparation design, and their interactions significantly impacted 3D seating of the restorations (p < 0.001). HC exhibited higer volumetric increase than RC. BJ and CA designs consistently demonstrated superior seating accuracy, irrespective of the luting material used. ConclusionsThe utilization of pre-heated composite resin could negatively influence the seating of overlay restorations, probably due to its higher viscosity when compared to the resin cement. However, when HC is selected as luting agent, preparation designs lacking internal angles are recommended for enhancing the precision of overlays seating.

Fracture Resistance of Direct versus Indirect Restorations on Posterior Teeth: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to compare static compression forces between direct composite resin restorations and indirect restorations for posterior teeth. All studies comparing mechanical properties of direct versus indirect restorations of posterior teeth were included from 2007 up to February 2024. A meta-analysis was conducted for static compression fracture resistance. Medline, Central, and Embase databases were screened. Twenty-four articles were included in the qualitative synthesis, and sixteen studies were finally included in the quantitative synthesis. There was no difference in terms of fracture resistance between direct and indirect restorations for posterior teeth (p = 0.16 for direct and indirect composite resin restorations and p = 0.87 for direct composite resin restorations and indirect ceramic restorations). Also, sub-group analysis with or without cusp coverage in each group revealed no discernable difference. Based on this study, it can be concluded that the choice between direct and indirect restoration approaches may not significantly impact fracture resistance outcomes. There was no statically significant difference between direct and indirect restorations for posterior teeth in all cases of restorations with or without cusp coverage and no matter the used materials. However, to better evaluate these materials, further studies are warranted.

Comparison of Various Commonly Used Luting Cements on the Success of Composite Inlays Assessed by the Levels of the Microleakage-An In vitro Study.

Indirect composite restoration is one of the commonly followed procedures in the posterior teeth. The success of this is dependent on many factors, one being the luting cement. Hence, the current study explores the microleakage of the two luting cements at 2 different times. Eighty extracted human teeth were taken, and class II cavities were made that were to receive the composite inlays. They were grouped as supragingival and subgingival, which for further divided as were further subdivided to be observed for marginal leakage at cervical and occlusal margins, at the end of a day and 1 month. Each group had ten specimens. The luting cements that were evaluated were Variolink N and RelyX Unicem. After the composite inlay restoration was done for all the specimens, the sections were put on slides, and a stereomicroscope was used to measure the amount of dye penetration. Leakage was evaluated and compared using Mann-Whitney U test. At the end of 1 day, there was no significant alteration in the microleakage in the occlusal or cervical regions for either region supragingivally or subgingivally between the two luting cements. Significant difference between the two cements at the cervical borders at the end of a month was seen for both the margins. When compared supragingivally and subgingivally at the end of 1 day or at the end of 1 month, there was not a significant difference for any of the cements. Within the constraints of the current investigation, it can be said that there was similar microleakage for both Variolink N and RelyX Unicem at the conclusion of a day's storage time. After a 1-month storage period, RelyX Unicem showed more cervical microleakage than Variolink N.

Last Generation Bis-GMA Free Composite For Indirect Posterior Restorations: A Case Report

Scientific literature put in evidence the importance to use biocompatible materials, free from any substance that can be toxic for the human body, for this reason a Bis-GMA free composite material is used that shows cytotoxicity equal to zero. Nowadays composite materials can be used with direct and indirect technique. In this case report we decided to provide an indirect composite restoration, this is an excellent option in absence of coronal destruction, as we improve the anatomic contour, and we also increase the physical properties as we also post curing the element in a light curing unit for indirect technique that must not exceed the 80°C /176 °F to avoid to damage the inorganic matrix of the composite.

Assessment of a highly-filled flowable composite for the repair of indirect composites.

To compare the shear-bond-strength (SBS) of a highly-filled-flowable composite (HFFC) and a paste-type composite for indirect composite repair and to evaluate the effect of different surface treatments (ST), concerning the composite repair protocol. Eighty-four 5 × 5 × 2 mm cylindrical specimens were prepared using Gradia Plus and SR Nexco indirect composite materials. The samples were thermocycled 5,000 times. According to the ST, the samples were divided into three groups (control, bur, and air-abrasion). After ST, the sample subgroups were divided into two sub-groups according to the repair material: paste-type composite and HFFC (n = 7). Another 5,000 cycles of aging were performed. SBS values were measured with a universal testing machine (Shimadzu, Japan). Shapiro-Wilk, 3-way ANOVA, and Tukey HSD test were used to evaluate data (P < 0.05). ST was considered significant for SBS (P < 0.001). The mean values were (13.9 ± 5.7), (17.0 ± 6.4), (20.4 ± 4.9) MPa for the control, bur and phosphoric acid, and air-abrasion groups, respectively. The surface treatment and repair material interaction was considered significant for SBS (P = 0.044). The highest mean bond strength (24.5 ± 4.5 MPa) was observed for the interaction of SR Nexco, air-abrasion ST, and HFFC repair. Repairing with HFFC following air abrasion might enhance the SBS for indirect composite restorations.

Effect of a Diode Laser (445 nm) on Polymerization Efficiency of a Preheated Resin Composite Used for Luting of Indirect Composite Restorations.

The aim of this study was to evaluate the polymerization efficiency of a preheated resin composite used as a luting agent for indirect restorations light-cured by a blue diode laser (445 nm). Bronze molds were used to prepare cylindrical specimens of a laboratory composite (Ceramage) with dimensions 2, 3, and 4 mm in height and 8 mm in diameter. The molds had additional height of 120 μm for the placement of the preheated resin composite. A nanohybrid resin composite (Enamel Plus HRi) was preheated at 55°C to use as a luting agent. Photopolymerization was followed for 20 seconds using three light sources: a diode laser emitting at 445 nm (SiroLaser Blue) and two light-emitting diode (LED) units (Bluephase Style and Valo). Degree of conversion (DC) of the preheated resin composite was evaluated using Fourier transform infrared spectroscopy. The results indicated that the main effects of the analysis were significant for both material thickness (p<0.001) and polymerization method (p<0.001). The preheated resin composite was not polymerized under 4-mm-thick specimens, independent of the light-curing unit. For 2-mm material thickness, there was no difference among the three light-curing units (p=0.383), while 3-mm Bluephase Style presented very low DC. Diode laser (445 nm) achieved better polymerization efficiency at the same fluence compared to the LED unit at 3-mm depth, implying a better mechanical behavior and potential improved adhesion of the luting material to dentin.

Direct or indirect composite for restoring permanent first molars affected by Molar Incisor Hypomineralisation (MIH): a randomized clinical controlled trial

AimThis study was undertaken to compare direct composite resin restorations (DCRR) and indirect composite resin restorations (ICRR) for treating permanent first molars affected by MIH in terms of clinical performance.Materials and methodsThis was a controlled, randomized, clinical split-mouth study. The studied sample consisted of 40 asymptomatic first permanent hypomineralised mandibular molars in 20 children aged between 7–11 years, these cases were divided randomly into two groups: Group 1 (experimental): 20 first permanent mandibular molars were restored with ICRR, and Group 2 (control): 20 first permanent mandibular molars that were restored with DCRR. The cavity was prepared using a diamond bur on a high-speed handpiece, and the prepared cavity was wiped with cotton moistened with sodium hypochlorite. The composite was applied directly with a total-etch bonding system. In the ICRR group, an impression for the prepared cavity was taken using a silicon-based material, and the restoration was adhesive with self-adhesive resin cement. The child’s satisfaction with each of the two application techniques was assessed through the scale FACES. Restorations were evaluated during follow-up periods (3, 6, and 12 months) according to Modified USHPH criteria.ResultsThe clinical success rate was 90% in the ICRR group versus 85% in the DCRR group after 12 months of follow-up without statistically significant differences (P = 0.218). Children were significantly more satisfied (P = 0.0351) with ICRR than DCRR.ConclusionsBoth DCRR and ICRR can be considered effective restorations with acceptable clinical performance in the restoration of hypomineralised first permanent molars with an advantage of ICRR in terms of child acceptance of the restoration application technique.

The comparison of the repair bond strength of the composite resin to direct and indirect composite restorations with different surface preparations.

Indirect restorations have been employed in restorative dentistry to solve some of the drawbacks of direct restorations. The aim of this study was to evaluate the effect of different modes of a universal adhesive resin on the repair capacity of two indirect resin composites and a direct resin composite. Indirect composite resins (Ceramage and Gradia Plus) and a direct composite resin (Filtek Z250) were prepared in a plastic mold with a height and diameter of 2-mm and 6-mm, respectively. Composite blocks were thermocycled (5000 cycles, 5°C-55°C). Then, according to their surface treatments, composite blocks were categorized into six-groups: Group 1: ER (etch&rinse), Group 2: SE (self-etch), Group 3: Bur+ER (bur+etch&rinse), Group 4: Bur+SE (bur+self-etch), Group 5: Bur+Silane+ER (bur+silane+etch&rinse), Group 6: Bur+Silane+SE (bur+silane+self-etch), respectively. After surface treatments and adhesive application for bonding with a direct resin composite, all groups were then thermocycled before performing shear-bond-strength-test. Failure modes were evaluated using a stereomicroscope. Data were analyzed by two-way-ANOVA and Bonferroni-test (P<0.05). The highest bond-strength values were obtained for Bur+Silane+SE groups, while the lowest values were obtained for the Bur+Silane+ER groups for all materials. Statistically significant differences were observed between the Bur+Silane+ER group and ER, Bur+ER and Bur+Silane+SE groups in Gradia Plus (P<0.05). The self-etch-mode of the universal-adhesive and silane applications led to the increase in the repair-strength of the adhesive in the Filtek Z250 and Ceramage. The self-etch-mode of the universal-adhesive might be used to reduce adhesive-application-steps in the clinical repair procedures.

Clinical survival and performance of premolars restored with direct or indirect cusp-replacing resin composite restorations with a mean follow-up of 14 years.

The objective is to evaluate the long-term clinical survival and performance of direct and indirect resin composite restorations replacing cusps in vital upper premolars. Between 2001 and 2007, 176 upper premolars in 157 patients were restored with 92 direct and 84 indirect resin composite restorations as part of an RCT. Inclusion criteria were fracture of the buccal or palatal cusp of vital upper premolars along with a class II cavity or restoration in the same tooth. Forty patients having 23 direct and 22 indirect composite restorations respectively, were lost to follow-up (25.6%). The cumulative Kaplan-Meier survival rates were 63.6% (mean observation time: 15.3 years, SE 5.6%) with an AFR of 2.4% for direct restorations and 54.5% (mean observation time: 13.9 years, SE: 6.4%) with an AFR of 3.3% for indirect restorations. The Cox regression analysis revealed a statistically significant influence of the patient's age at placement on the survival of the restoration (HR 1.036, p=0.024), the variables gender, type of upper premolar, type of restoration, and which cusp involved in the restoration had no statistically significant influence. Direct composite restorations failed predominantly due to tooth fracture, indirect restorations primarily by adhesive failure (p<0.05). There was no statistically significant difference in survival rates between direct and indirect composite cusp-replacing restorations. Both direct and indirect resin composite cusp-replacing restorations are suitable options to restore compromised premolars. The longer treatment time and higher costs for the indirect restoration argue in favor of the direct technique.

Effect of Air Abrasion on Delayed Dentin Sealing Post-operative Sensitivity for Indirect Resin Composite Restorations

BACKGROUND: There are several treatment options available to reduce the post-operative sensitivity (POS) of indirect resin composite restorations. AIM: This study was to evaluate the effect of air abrasion on delayed dentin sealing POS for indirect resin composite restorations. MATERIALS AND METHODS: Twenty-eight patients between the ages of 18 and 30 were enrolled and randomly assigned to one of two treatment groups, with 14 teeth (n = 14) in each group. Following the collection of baseline pre- operative data, the diagnosis of caries was made based on the clinical examination and radiographic examination, and all cavities were prepared. Group one (G1) prepared cavities were exposed to airborne particles before the selective etch technique was used without the use of cementation, and the selective etch technique was used. In the second group (G2), air abrasion during cementation. The visual analog scale was used to evaluate POS at baseline, 1 day after cavity preparation (T1), 1 week after indirect composite restoration cementation (T2), 3 months (T3), and 12 months (T4). STATISTICAL ANALYSIS USED: The one-sample Kolmogorov–Smirnov test was used to assess the normality of distribution parameters first, and then, for non-parametric distributions, the Kruskal–Wallis test was used to assess the interaction between different variables. The Mann–Whitney U-test was then used to compare the two groups. RESULTS: Despite air abrasion’s effect, there was no statistically significant change in scores between the G1 and G2 groups. POS was highest at T1, then T2, T3, and T4. Statistically, these differences were significant (p = 0.001). No statistically significant differences (p &gt; 0.05) were found between T2, T3, and T4 with or without air abrasion. CONCLUSION: The delayed dentin sealing POS is unaffected by air abrasion during indirect resin restorations’ cementation.

Effect of Immediate Dentin Sealing with Air Abrasion on Post-operative Sensitivity for Indirect Resin Composite Restorations

Background: Various treatment modalities are available to decrease the postoperative sensitivity of indirect resin composite restorations.&#x0D; Aim: Compare the effectiveness of immediate dentin sealing using universal adhesive and air abrasion versus immediate dentin sealing without air abrasion on postoperative sensitivity in teeth prepared for indirect resin composite restorations.&#x0D; Methods and Materials: Twenty-eight patients between 18 and 30 years of age were recruited and randomized to two treatment protocols with fourteen teeth (n = 14) included in each protocol. After baseline preoperative data collection, the diagnosis of caries was made depending on the clinical examination and radiographic examination. After cavity preparation was done, all cavities in each protocol were managed with immediate dentin sealing, and the single-bond universal adhesive was applied over all the dentinal surfaces according to the manufacturer’s instructions. Protocol One (P1) air abrasion was used for immediate dentin sealing before cementation. In the second protocol (P2), the dentin was sealed without the use of air abrasion. Postoperative sensitivity (POS) was evaluated using the Visual Analog Scale (VAS) at baseline, one day after the cavity preparation (T1), one-week post-cementation of the indirect composite restoration (T2), after 3 months (T3), and after 12 months (T4).&#x0D; Statistical analysis used: The normality of distribution parameters was evaluated by one-sample Kolmogorov-Smirnov first, and then, for nonparametric distribution, the Kruskal-Wallis Test was used to test the interaction between different variables. followed by the Mann-Whitney U test to compare the two groups.&#x0D; Results: Despite air abrasion's effect, there was no statistically significant change in scores between the P1 and P2 groups. Postoperative sensitivity was highest at T1, then T2, T3, and T4. Statistically, these differences were significant (P 0.001). No statistically significant differences (P &gt; 0.05) were found between T2, T3, and T4 with or without air abrasion.&#x0D; Conclusion: Air abrasion during cementation of indirect resin restorations does not affect postoperative sensitivity after immediate dentin sealing.&#x0D; Keywords: Immediate dentin sealing, Air abrasion, surface treatment, Visual Analog Scale (VAS), Postoperative sensitivity.&#x0D; Key Messages: Air abrasion applied to immediate dentin sealing can be used safely without affecting postoperative sensitivity.

Thirty-three-year clinical performance of premolar indirect composite restorations seated with 4-META-MAC 10 combined adhesive system

Thirty-three-year clinical performance of premolar indirect composite restorations seated with 4-META-MAC 10 combined adhesive system

Marginal and Internal Adaptation of Cervical Restorations Using Direct, Direct-indirect, and Indirect Techniques.

This study aimed to evaluate the external and internal adaptations of cervical restorations using different restorative techniques. Forty extracted and intact human premolars received standardized cervical preparations to simulate non-carious cervical lesions. The teeth were randomly divided into four groups (n=10) according to the restorative technique: D, direct composite restoration without a base (Palfique LX5, Tokuyama Dental Corp Inc, Tokyo, Japan); DB, direct composite restoration with a flowable composite liner (Estelite Flow Quick -High Flow, Tokuyama Dental Corp Inc); DI, direct-indirect composite restoration bonded with flowable composite; and I, indirect restoration bonded with flowable composite. Marginal adaptation of the restorations was observed in different segments of the margins using a scanning electron microscope. Analyses of internal adaptation were performed using micro-computed tomography. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of the data (α=5%). No significant differences were found in the marginal adaptation of the groups (p>0.05), although a significantly higher percentage of continuous margin was found in the proximal segment than in the cervical segment (p<0.05). No significant differences were detected between the groups in terms of internal adaptation (p>0.05). All the restorative techniques evaluated for the restoration of cervical lesions performed similarly in terms of marginal and internal adaptation.

Primary failure of eruption (PFE) - a systematic literature review

Introduction and purpose&#x0D; Primary Failure of Eruption (PFE) is a rare disease that occurs more often in women than in men. PFE is extremely important for orthodontists because conventional treatment of patients results in ankylosis of the teeth affected by the disease. The aim of the study is to discuss the epidemiology, etiology, diagnosis and treatment of Primary Failure of Eruption.&#x0D; Description of the state of knowledge&#x0D; PFE is present in 0.05% to 0.6% of the population. The average incidence is at the age of 13.65, more often in women. Most often it affects the lateral teeth, and therefore it results in open lateral bites because the teeth do not reach the occlusal plane. The condition was found to be of genetic origin and inherited autosomal dominantly with a low percentage of incomplete penetration. The gene responsible for the disease is the PTH1R. The diagnosis of the disease consists in excluding other causes of eruption failure, detecting disease in which such symptoms occur, and genetic tests (NGS). Treatment of an open lateral bite cannot be carried out in a conventional manner due to the deterioration of the condition after the application of orthodontic forces. The result of the above actions is ankylosis of teeth covered by PFE. The currently proposed methods of treatment are: single or multi-site osteotomy, selective extractions with subsequent implantations, direct or indirect composite restorations, distraction osteogenesis, removable prosthetic restorations.&#x0D; Summary&#x0D; Properly conducted clinical examination of the patient should take into account PFE. Genetic testing (PTH1R) is important in the diagnosis of people with eruption disorders, which is crucial for achieving partially positive treatment results. Orthodontic treatment is contraindicated and patients with a PTH1R mutation should be monitored long-term until their growth is complete, which is the time when interdisciplinary treatment is initiated.

Finite element and in vitro study on biomechanical behavior of endodontically treated premolars restored with direct or indirect composite restorations

Objectives of the study were to investigate biomechanical properties of severely compromised premolars restored with composite restorations using finite element analysis (FEA), and in vitro fracture resistance test. A 3-D model of an endodontically treated premolar was created in Solidworks. Different composite restorations were modelled (direct restoration-DR; endo-crown-EC; post, core, and crown-C) with two different supporting tissues: periodontal ligament/alveolar bone (B), and polymethyl methacrylate (PMMA). Models were two-point axially loaded occlusally (850 N). Von Mises stresses and strains were calculated. The same groups were further tested for static fracture resistance in vitro (n = 5, 6.0 mm-diameter ball indenter, vertical load). Fracture resistance data were statistically analyzed (p < 0.050). The highest stresses and strains in all FEA models were observed on occlusal and vestibular cervical surfaces, corresponding to fracture propagation demonstrated in vitro. C showed the lowest stress in dentin, while EC showed lower stresses and strains in crown cement. B models demonstrated larger high stress areas in the root than PMMA models. No significant differences in fracture resistance (N) were observed between groups (DR: 747.7 ± 164.0, EC: 867.3 ± 108.1, C: 866.9 ± 126.3; p = 0.307). More conservative restorations seem a feasible alternative for endodontically treated premolars to conventional post-core-crown.

Treatment of cracked teeth: A comprehensive narrative review.

ObjectivesThe term “cracked tooth” is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up‐to‐date comprehensive overview regarding the treatment of cracked teeth.Materials and MethodsAn electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several “Grey literature” sources up to February 22nd 2022 using a combination of pre‐specified ‘free‐text' terms (keywords) and “subject headings.” The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow‐up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full‐text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers.ResultsIn total, 64 articles were selected for inclusion in this narrative review.ConclusionsCracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non‐cracked root filled teeth.

The effect of atmospheric pressure on the bond strength of composites.

Background: In the current study, we investigated the effect of atmospheric pressure change on the microtensile bond strength of direct and indirect composite restorations to the teeth. Materials and Methods: A total of 16 extracted teeth were prepared after crown cutting and randomly divided into four groups. The study groups included: 1) direct restoration (Filtek™ Z250 Universal Composite Restorative System, 3M, United States) at constant pressure (control); 2) direct restoration in variable pressure; 3) indirect restoration (Z250 composite) at constant pressure (control); and 4) indirect restoration at variable pressure. Then, samples were subjected to thermal cycles. Variable pressure groups were pressurized to 0 to 5 atmospheres for 96 cycles inside the hyperbaric chamber, followed by measuring the microtensile bond strength of the specimens. Results: The mean of microtensile bond strength in both direct and indirect variable-pressure groups was significantly lower than their counterpart control groups. There was no significant difference between direct and indirect restorations in constant and variable pressure. The failure mode of the samples in the control groups was often mixed, while in the pressure groups, it was dominated by adhesive. Also, microscopic examination of restoration interfaces showed that the number and volume of voids in variable pressure groups were much more than the control groups. Conclusion: Regardless of the type of restoration, changing the atmospheric pressure is effective on the bond strength of the restorations to the teeth.

Indirect composite inlay restoration: A case report

In several deterioration cases , composite competes with amalgams, metallic and ceramic inlays. In relatively small cavities of posterior teeth, utility of direct composite restorations is restricted due to its polymerisation stresses. A much-appreciated alterative to ceramics in posterior teeth is indirect composite. Due to recent technological advancements in composite materials and bonding techniques, its use escalates steadily. Touati and Mormann introduced the first generation of indirect resins composite in early 1980s. Although there is a successful accomplishment in direct composite restoration, the use of composite restoration with indirect or extra-oral method remains ambiguous. In this article, we will inquire into composite systems used at the laboratory for indirect restoration in a clinical ground.

Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study.

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.

Аналіз даних систематичних оглядів та мета-аналізів щодо успішності застосування непрямих композитних реставрацій у стоматологічній практиці

Introduction. The prognosis of the success regarding therapeutic treatment of hard dental tissue defects depends on a number of factors, including those related to the experience of the dentist, the specifics of the clinical situation, the specifics of the technology used for the defect filling/restoration and the type of restoration. Objective – to analyze the success rates of indirect composite restorations according to the systematic reviews and meta-analytical studies, and compare them with the success rates of direct composite restorations and partial ceramic restorations. Methodology/Methods. The research was organized in the form of retrospective analysis of data extracted from systematic reviews and meta-analytical studies. The primary cohort of publications was formed from the number of available reseraches within the PubMed database (https://pubmed.ncbi.nlm.nih.gov/) after provided targeted search using the appropriate Mesh-terms. Results and Discussion. It was not possible to verify the evidence-based difference between the success rate of direct and indirect composite restorations after processing the data extracted from the systematic reviews and meta-analyzes, which can be argued by the heterogeneity of analyzed studies designs, differences within clinical conditions under which different types of restorations were used, and distinctions within the criteria, which were used to assess the functional status of the restorations. Conclusions. Only some evidences of low and medium quality obtained after processing the data extracted from systematic reviews and meta-analyzes, indicated a higher success rate of indirect composite restorations compare to such registered among direct ones during similar performance period. A statistically confirmed difference between the success rete of direct and indirect composite restorations based on the high quality evidences could not be identified. In the short term perspective indirect partial ceramic restorations characterized by a higher success rete compared to indirect composite restorations during the analysis of such with relatively similar design.