Longevity of Repair Versus Replacement of Partially Fractured Direct Composite Restorations in Permanent Teeth: A...

The present systematic review evaluates the comparative longevity of repaired versus replaced partially fractured direct composite restorations in permanent teeth. The decision to repair or replace a fractured restoration is a significant clinical consideration, influencing functional stability, esthetics, and preservation of tooth structure. Following the PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science was conducted using predefined keywords. Inclusion criteria encompassed clinical and laboratory studies assessing the longevity, success rate, and failure parameters of repaired and replaced restorations. The methodological quality of observational studies was assessed using the Newcastle-Ottawa Scale, while interventional studies were evaluated using the Cochrane Risk of Bias (ROB-2) tool. A meta-analysis was performed to compare restoration longevity based on parameters such as marginal adaptation, anatomic form, surface roughness, marginal staining, and secondary caries. Nine studies published between 2006 and 2018 were included, with follow-up periods ranging from 2 to 15 years. The meta-analysis revealed that repaired restorations demonstrated superior marginal adaptation (RR = 0.47; p < 0.05) and lower secondary caries incidence (RR = 0.72; p > 0.05), favouring repair over replacement. However, no significant differences were found for anatomic form, surface roughness, or marginal staining. While the methodological quality varied, studies consistently highlighted the benefits of repair in preserving tooth structure and minimizing treatment invasiveness. Repaired composite restorations offer comparable longevity to complete replacement while conserving more tooth structure and reducing patient discomfort. The findings advocate for prioritizing repair as a conservative approach before opting for full restoration replacement. Further longitudinal studies with standardized protocols are needed to optimize restorative strategies.